WEBVTT 00:00:00.000 --> 00:00:02.620 This episode is sponsored by Transcend, a veteran 00:00:02.620 --> 00:00:04.960 -owned and operated performance optimization 00:00:04.960 --> 00:00:08.039 company that I introduced recently as a sponsor 00:00:08.039 --> 00:00:10.820 on this show. Well, since then I have actually 00:00:10.820 --> 00:00:13.080 been using my products and I have had incredible 00:00:13.080 --> 00:00:15.939 success. There was initial blood work that was 00:00:15.939 --> 00:00:19.039 extremely detailed and based on that they offered 00:00:19.039 --> 00:00:23.559 supplementation. So I began taking DHEA. bpc 00:00:23.559 --> 00:00:26.539 157 for inflammation based on the fact that i've 00:00:26.539 --> 00:00:28.859 been a stuntman a martial artist and a firefighter 00:00:28.859 --> 00:00:31.980 my whole life lots of aches and pains dihexa 00:00:31.980 --> 00:00:34.759 to help cognition after multiple punches to the 00:00:34.759 --> 00:00:37.820 head and shift work and peptides four months 00:00:37.820 --> 00:00:40.119 later they did a detailed blood work again and 00:00:40.119 --> 00:00:43.119 i was actually able to taper off two of the peptides 00:00:43.119 --> 00:00:45.640 because my body had responded so well to just 00:00:45.640 --> 00:00:48.079 one of them that it was optimized at that point 00:00:48.570 --> 00:00:51.890 So I cannot speak highly enough of the immense 00:00:51.890 --> 00:00:54.390 range of supplementation that they offer, whether 00:00:54.390 --> 00:00:57.409 it's male health, female health, peptides to 00:00:57.409 --> 00:00:59.429 boost your own testosterone, which I would argue 00:00:59.429 --> 00:01:02.429 is needed by a lot of the fire service, or whether 00:01:02.429 --> 00:01:04.569 it's exogenous testosterone needed, especially 00:01:04.569 --> 00:01:08.000 after TBIs or advanced age. Now, as I mentioned 00:01:08.000 --> 00:01:10.379 before, the other side of this company is an 00:01:10.379 --> 00:01:12.900 altruistic arm called the Transcend Foundation, 00:01:13.420 --> 00:01:15.980 which is putting veterans and first responders 00:01:15.980 --> 00:01:19.120 through some of their protocols free of charge. 00:01:19.379 --> 00:01:22.079 Now, Transcend are also offering you, the audience, 00:01:22.239 --> 00:01:25.319 10 % off their protocols. And you can find that 00:01:25.319 --> 00:01:28.040 on jamesgearing .com under the Products tab. 00:01:28.400 --> 00:01:30.859 And if you want to hear more about Transcend 00:01:30.859 --> 00:01:34.560 and their story, listen to episode 808 with the 00:01:34.560 --> 00:01:38.930 founder, Ernie Colling. or go to transcendcompany 00:01:38.930 --> 00:01:43.890 .com. This episode is sponsored by TeamBuildr, 00:01:43.909 --> 00:01:45.989 yet another company that's doing great things 00:01:45.989 --> 00:01:49.109 for the first responder community. As a strength 00:01:49.109 --> 00:01:51.390 and conditioning coach myself, who also trains 00:01:51.390 --> 00:01:54.590 tactical athletes, dissemination of wellness 00:01:54.590 --> 00:01:56.730 information is one of the biggest challenges. 00:01:57.430 --> 00:01:59.670 Now, TeamBuildr is the premier strength and 00:01:59.670 --> 00:02:02.030 conditioning software for tactical athletes. 00:02:02.329 --> 00:02:04.790 And there are several features that really impress 00:02:04.790 --> 00:02:08.300 me. Firstly, there is a full exercise library. 00:02:08.460 --> 00:02:10.780 So you, the personal trainer, does not have to 00:02:10.780 --> 00:02:13.939 create that within your own department. Secondly, 00:02:14.120 --> 00:02:17.439 you can send out programming, but also individualize, 00:02:17.500 --> 00:02:20.280 which I love. So you blanket program for everyone. 00:02:20.479 --> 00:02:23.219 Now you can tweak based on someone's injury, 00:02:23.419 --> 00:02:25.900 someone's need to maybe drop some body composition, 00:02:25.939 --> 00:02:28.860 rather than having to write a program for every 00:02:28.860 --> 00:02:31.639 single person on their own. TeamBuilr also 00:02:31.639 --> 00:02:34.099 allows you to build custom questionnaires to 00:02:34.099 --> 00:02:37.139 collate health and wellness data. It integrates 00:02:37.139 --> 00:02:39.699 with wearables. And I think one of the most important 00:02:39.699 --> 00:02:43.520 things is obviously it tracks. To me, it's imperative 00:02:43.520 --> 00:02:46.979 that we as a profession start tracking our people 00:02:46.979 --> 00:02:50.879 from day one and then over the full span of their 00:02:50.879 --> 00:02:54.099 career, therefore catching potential wellness 00:02:54.099 --> 00:02:57.620 issues and injuries before they happen. Now, 00:02:57.639 --> 00:02:59.860 if you want to try Team Builder, they are offering 00:02:59.860 --> 00:03:02.199 you, the audience of the Behind the Shield podcast, 00:03:02.599 --> 00:03:06.819 a free 14 -day trial to experience all of the 00:03:06.819 --> 00:03:09.340 features. And if you want to take a deeper dive 00:03:09.340 --> 00:03:13.860 into TeamBuildr, listen to episode 1032 with 00:03:13.860 --> 00:03:17.879 Melissa Mercado or go to teambuilder .com. And 00:03:17.879 --> 00:03:19.419 I'll spell that to you because it's not as you 00:03:19.419 --> 00:03:25.909 think, T -E -A -M -B -U -I -L -D -R .com. Welcome 00:03:25.909 --> 00:03:27.669 to the Behind the Shield podcast. As always, 00:03:27.689 --> 00:03:29.530 my name is James Gearing, and this week it is 00:03:29.530 --> 00:03:32.469 my absolute honor to welcome on the show emergency 00:03:32.469 --> 00:03:36.310 room physician, medical director, and the creator 00:03:36.310 --> 00:03:41.830 of the Hantevi system, Dr. Peter Hantevi. Now, 00:03:41.830 --> 00:03:45.530 I first sat down with Peter on episode 213 back 00:03:45.530 --> 00:03:48.889 in 2019, so as you can imagine, there was a huge 00:03:48.889 --> 00:03:52.310 amount to discuss. from school safety to the 00:03:52.310 --> 00:03:54.750 use of whole blood in the pre -hospital setting 00:03:54.750 --> 00:03:59.409 to ketamine therapy and so much more. Now, before 00:03:59.409 --> 00:04:01.569 we get to this incredible conversation, as I 00:04:01.569 --> 00:04:04.789 say every week, please just take a moment, go 00:04:04.789 --> 00:04:07.430 to whichever app you listen to this on, subscribe 00:04:07.430 --> 00:04:11.199 to the show. Leave feedback and leave a rating. 00:04:11.599 --> 00:04:15.280 Every single five -star rating truly does elevate 00:04:15.280 --> 00:04:18.040 this podcast, therefore making it easier for 00:04:18.040 --> 00:04:21.720 others to find. And this is a free library of 00:04:21.720 --> 00:04:26.860 almost 1 ,100 episodes now. So all I ask in return 00:04:26.860 --> 00:04:30.180 is that you help share these incredible men and 00:04:30.180 --> 00:04:33.319 women's stories so I can get them to every single 00:04:33.319 --> 00:04:36.259 person on planet Earth who needs to hear them. 00:04:37.199 --> 00:04:39.959 So with that being said, I welcome back onto 00:04:39.959 --> 00:05:04.269 the show Dr. Peter and Tevi. Enjoy. Well, Peter, 00:05:04.370 --> 00:05:07.110 I want to start by saying firstly, thank you 00:05:07.110 --> 00:05:09.410 for coming back on to the Behind the Shield podcast. 00:05:09.569 --> 00:05:13.750 We did our first conversation episode 213 in 00:05:13.750 --> 00:05:17.370 May 2019. So obviously there's many, many world 00:05:17.370 --> 00:05:19.009 events that have happened since then that I'd 00:05:19.009 --> 00:05:22.029 love to kind of dive into at some point. But 00:05:22.029 --> 00:05:24.110 I want to start by welcoming you back onto the 00:05:24.110 --> 00:05:27.209 Behind the Shield podcast today. James, so happy 00:05:27.209 --> 00:05:30.009 to be back. 2019, I felt like I was just a little 00:05:30.009 --> 00:05:33.420 baby in EMS at the time. getting my feet wet. 00:05:33.779 --> 00:05:36.199 A lot of things were happening for me at the 00:05:36.199 --> 00:05:40.680 time. And I've grown quite a bit. I've matured 00:05:40.680 --> 00:05:43.680 quite a bit. And I'm really excited to get back 00:05:43.680 --> 00:05:46.079 and talk to you about what's happened in the 00:05:46.079 --> 00:05:48.259 past and maybe even what we're looking forward 00:05:48.259 --> 00:05:51.100 to in the future. Absolutely. So even though 00:05:51.100 --> 00:05:53.319 we took a deep dive before, because it was so 00:05:53.319 --> 00:05:55.319 long ago, and for anyone who's listened to that 00:05:55.319 --> 00:05:57.740 episode, there was a screaming AC unit in the 00:05:57.740 --> 00:06:00.220 background when we were recording. I'd just love 00:06:00.220 --> 00:06:03.439 to kind of revisit again. So let's start from 00:06:03.439 --> 00:06:05.300 the very beginning. Tell me where you were born 00:06:05.300 --> 00:06:07.180 and tell me a little bit about your family dynamic, 00:06:07.439 --> 00:06:10.579 what your parents did, how many siblings. Oh, 00:06:10.600 --> 00:06:14.279 wow. Let's go back to that. So I was born in 00:06:14.279 --> 00:06:18.819 Hollywood, Florida in 1972. And I say that because 00:06:18.819 --> 00:06:23.839 my parents immigrated to the United States on 00:06:23.839 --> 00:06:28.600 a boat from Israel into Ellis Island with my 00:06:28.600 --> 00:06:32.819 grandfather. And why that's important in my history 00:06:32.819 --> 00:06:39.319 is because my grandfather was born in Iraq because 00:06:39.319 --> 00:06:41.620 of what was all the badness happening there. 00:06:41.779 --> 00:06:47.100 He left at a very young age to Israel before 00:06:47.100 --> 00:06:51.560 Israel was even a state. He joined the army. 00:06:51.699 --> 00:06:54.629 He actually helped create. He was one of the 00:06:54.629 --> 00:06:57.730 leaders helping create the state of Israel. And 00:06:57.730 --> 00:07:00.250 then they got to a point where my grandfather, 00:07:00.410 --> 00:07:03.189 for some reason, him and his brother said, hey, 00:07:03.290 --> 00:07:06.009 let's get on a boat and go figure out this place 00:07:06.009 --> 00:07:09.149 called America. So just imagine the mindset of 00:07:09.149 --> 00:07:11.490 people who have already left one country for 00:07:11.490 --> 00:07:14.610 another and then going to get on a boat and go 00:07:14.610 --> 00:07:18.290 to another country and move everybody along with 00:07:18.290 --> 00:07:21.129 them. They get here and they lose everything. 00:07:21.290 --> 00:07:24.100 They go back to zero. And at that time, my grandfather 00:07:24.100 --> 00:07:26.519 is now 52 years old, which is the age I am today, 00:07:26.699 --> 00:07:31.920 went to zero. And then he just got back up on 00:07:31.920 --> 00:07:34.500 his feet, didn't complain, never complained about 00:07:34.500 --> 00:07:37.019 any of the badness that happened, and just rebuilt 00:07:37.019 --> 00:07:41.860 his life and ultimately his daughter, my mom, 00:07:41.920 --> 00:07:46.959 and my dad after they got married. And they ended 00:07:46.959 --> 00:07:49.139 up doing, you know, we ended up living, growing 00:07:49.139 --> 00:07:53.370 up very middle class. But very happy. I have 00:07:53.370 --> 00:07:57.990 three siblings who we were raised in a very like 00:07:57.990 --> 00:08:01.810 hardworking, very ethical, like we care about 00:08:01.810 --> 00:08:04.310 people. We care more about others than we care 00:08:04.310 --> 00:08:07.230 about ourselves. But more importantly, there 00:08:07.230 --> 00:08:10.170 is this kind of innovation mindset. There is 00:08:10.170 --> 00:08:14.790 a forward moving mindset. There is a don't listen 00:08:14.790 --> 00:08:17.620 to what other people are saying. But think about 00:08:17.620 --> 00:08:20.120 what you want to do and then go accomplish that 00:08:20.120 --> 00:08:24.439 goal. And so I think that looking back, what 00:08:24.439 --> 00:08:27.819 I try and give my three boys today, Allison and 00:08:27.819 --> 00:08:30.300 I both try and do this, is that we try to give 00:08:30.300 --> 00:08:33.899 them that same feeling of remember where you 00:08:33.899 --> 00:08:36.240 came from, because that's the kind of person 00:08:36.240 --> 00:08:38.139 that you're going to be. And that's the kind 00:08:38.139 --> 00:08:40.120 of people that your children will end up being. 00:08:40.220 --> 00:08:42.960 So that's kind of the important part of my background 00:08:42.960 --> 00:08:45.879 as I see it. And I'm very, very blessed to have 00:08:45.879 --> 00:08:48.419 the family that I have, the relationships that 00:08:48.419 --> 00:08:52.100 I have, and the upbringing that I had. When you 00:08:52.100 --> 00:08:54.039 say your grandfather came from Iraq, was he Jewish 00:08:54.039 --> 00:08:56.240 in Iraq or was he Muslim? He was Jewish in Iraq. 00:08:56.580 --> 00:08:58.960 Yeah, yeah, yeah. My family's Jewish and they 00:08:58.960 --> 00:09:02.360 were being persecuted. And there was, you know, 00:09:02.360 --> 00:09:04.480 because remember back in the day, there was many, 00:09:04.559 --> 00:09:06.919 many Jews in Iraq. It was a huge bustling Jewish 00:09:06.919 --> 00:09:11.100 place and it was safe for them. And then it wasn't. 00:09:11.600 --> 00:09:14.860 And so they all basically had to leave Iraq and 00:09:14.860 --> 00:09:18.320 they had to find another place for safety. It 00:09:18.320 --> 00:09:20.480 seems that, again, we were just talking before 00:09:20.480 --> 00:09:22.559 we hit record, the book I just wrote was about 00:09:22.559 --> 00:09:24.340 generational trauma. And this is what we're seeing 00:09:24.340 --> 00:09:26.960 even today. I mean, the ripple effect of the 00:09:26.960 --> 00:09:30.460 good and the ripple effect of the bad. It is. 00:09:30.539 --> 00:09:32.279 And by the way, I'm going to Israel in about 00:09:32.279 --> 00:09:36.600 two weeks from now. And, you know, every day 00:09:36.600 --> 00:09:39.600 I check my airline to see if they haven't canceled 00:09:39.600 --> 00:09:43.629 it because. People there live in fear and it's 00:09:43.629 --> 00:09:45.649 horrible what's going on over there, but it's 00:09:45.649 --> 00:09:48.929 very unsafe. And there's a lot of trauma that's 00:09:48.929 --> 00:09:50.750 occurring today in many people that's going to 00:09:50.750 --> 00:09:53.429 last them a lifetime. Absolutely. Well, you mentioned 00:09:53.429 --> 00:09:55.149 about growing up in a middle -class family. What 00:09:55.149 --> 00:09:57.649 were your parents doing profession -wise? Yeah. 00:09:57.710 --> 00:10:01.350 So my dad was an upholsterer, right? So you would 00:10:01.350 --> 00:10:04.029 say, hey, my couch is ripped. uh or i need new 00:10:04.029 --> 00:10:07.289 vertical blinds and we like literally my dad 00:10:07.289 --> 00:10:12.269 had a an econoline 150 white van which we loved 00:10:12.269 --> 00:10:14.889 because we used to put mattresses in it and and 00:10:14.889 --> 00:10:17.190 go to the keys it was you know it was that kind 00:10:17.190 --> 00:10:19.750 of childhood stated to howard johnson's six people 00:10:19.750 --> 00:10:22.009 in one room like like that's what i remember 00:10:22.009 --> 00:10:24.570 the greatness of my childhood uh that's part 00:10:24.570 --> 00:10:26.970 of it uh so my dad was an upholsterer his whole 00:10:26.970 --> 00:10:30.909 career on his own little upholstery shop My mom, 00:10:31.009 --> 00:10:33.470 and by the way, he never got a degree, never 00:10:33.470 --> 00:10:36.330 got a high school degree, never got a college 00:10:36.330 --> 00:10:41.169 degree. My mom never got a college degree until 00:10:41.169 --> 00:10:43.629 all of us went to college. Then she went and 00:10:43.629 --> 00:10:46.830 got her AA degree, became a travel agent. Obviously, 00:10:46.850 --> 00:10:48.570 was working with my dad in the front office, 00:10:48.649 --> 00:10:53.029 if you will, for that time as well. And so, yeah, 00:10:53.049 --> 00:10:55.470 travel agent and an upholsterer. Believe that. 00:10:55.969 --> 00:10:58.190 So when you were a child, were you already thinking 00:10:58.190 --> 00:11:00.190 about medicine or was there something else in 00:11:00.190 --> 00:11:05.230 your mind? So this is funny. And the only way 00:11:05.230 --> 00:11:08.330 that I know this is true is because my aunt years 00:11:08.330 --> 00:11:12.029 ago found the yearbook from my middle school 00:11:12.029 --> 00:11:16.769 because her son and I were in the same class 00:11:16.769 --> 00:11:19.049 and she kept the yearbook from, I don't know 00:11:19.049 --> 00:11:21.509 what grade it was, but the picture of me was 00:11:21.509 --> 00:11:23.809 on a tricycle. Okay, that's just so you understand. 00:11:24.679 --> 00:11:27.019 And for whatever reason, they had every student 00:11:27.019 --> 00:11:29.320 at the bottom put, what did you want to do when 00:11:29.320 --> 00:11:31.740 you grow up? And at the bottom of this picture, 00:11:31.879 --> 00:11:35.940 which I have, it says pediatrician. What? Not 00:11:35.940 --> 00:11:38.679 even doctor, specifically pediatrician. Right. 00:11:38.720 --> 00:11:41.519 And why? Because my pediatrician, Dr. Patel, 00:11:41.559 --> 00:11:45.019 may he rest in peace, was a legend, right? This 00:11:45.019 --> 00:11:47.820 guy was legendary. And he was so good that when 00:11:47.820 --> 00:11:50.799 we used to want to have to go somewhere. And 00:11:50.799 --> 00:11:52.899 it was going to the doctor where every kid would 00:11:52.899 --> 00:11:55.240 be like, no, I'm not going. We were like, we 00:11:55.240 --> 00:11:57.179 can't wait to go to Dr. Patel's office. He had 00:11:57.179 --> 00:12:01.940 toys in there and you go into that little case 00:12:01.940 --> 00:12:04.779 and you pick up a toy. And he was just, for whatever 00:12:04.779 --> 00:12:08.200 reason, exuded something in me that I said, I 00:12:08.200 --> 00:12:10.860 want to be like that guy. And that's what I wrote. 00:12:11.539 --> 00:12:13.299 Beautiful. Well, kind of walk me through your 00:12:13.299 --> 00:12:16.320 journey then. What was that educational journey 00:12:16.320 --> 00:12:18.399 and which field did you find yourself in first? 00:12:19.789 --> 00:12:23.070 So the educational journey, if we had time to 00:12:23.070 --> 00:12:25.610 talk over a bourbon, the interesting part of 00:12:25.610 --> 00:12:28.309 my educational journey is that I went to college, 00:12:28.389 --> 00:12:31.710 University of Florida. And then I thought that 00:12:31.710 --> 00:12:33.269 I'm a smart guy. I'm just going to get into medical 00:12:33.269 --> 00:12:36.429 school. But it turns out that I didn't get into 00:12:36.429 --> 00:12:39.990 medical school. I was tutoring all these kids 00:12:39.990 --> 00:12:42.269 who all got in. They all had worse grades than 00:12:42.269 --> 00:12:45.429 me. They all got in. I didn't get in. I don't 00:12:45.429 --> 00:12:47.789 know the reason. Remember, my parents had never 00:12:47.789 --> 00:12:50.539 been to college before. There was zero, like, 00:12:50.600 --> 00:12:52.360 you know, parents today are on top of their kids 00:12:52.360 --> 00:12:54.539 and you write the essay for them. My parents 00:12:54.539 --> 00:12:59.340 said, what's college? Make sure you call. And 00:12:59.340 --> 00:13:04.220 what are you eating? So we had zero, like nobody 00:13:04.220 --> 00:13:08.220 was helping me do anything. So I kind of got 00:13:08.220 --> 00:13:10.700 there. I did okay, but not good enough clearly 00:13:10.700 --> 00:13:14.480 in their eyes to get in. So I ended up applying 00:13:14.480 --> 00:13:17.250 to a foreign medical school in Grenada. Best 00:13:17.250 --> 00:13:19.970 decision I ever made looking back at it. And 00:13:19.970 --> 00:13:21.929 then two years into Grenada. So remember, I'm 00:13:21.929 --> 00:13:27.029 living on a third world island. And it was very 00:13:27.029 --> 00:13:30.750 good for me personally, because here I was surrounded 00:13:30.750 --> 00:13:32.730 by a lot of people that I knew and never really 00:13:32.730 --> 00:13:35.809 came out of my shell. There, I suddenly became 00:13:35.809 --> 00:13:39.690 who I was. And I became the class president. 00:13:40.169 --> 00:13:42.889 No idea about leadership. I just figured people 00:13:42.889 --> 00:13:44.830 wanted me to become the president. I don't know 00:13:44.830 --> 00:13:47.789 how all that happened. But I learned more about 00:13:47.789 --> 00:13:51.850 who I was in Grenada. And then I ended up transferring 00:13:51.850 --> 00:13:56.570 into University of Miami. Stroke of luck, right 00:13:56.570 --> 00:13:59.350 place, right time, persistence, whatever you 00:13:59.350 --> 00:14:02.370 want to call it. I was one of only, I think, 00:14:02.370 --> 00:14:05.629 two people who were able to transfer. And then 00:14:05.629 --> 00:14:10.139 graduated University of Miami. And then when 00:14:10.139 --> 00:14:13.059 I wanted to go to a top pediatric residency program, 00:14:13.340 --> 00:14:16.440 the dean there said, Pete, you come from a foreign 00:14:16.440 --> 00:14:18.600 medical school. No one's going to take you at 00:14:18.600 --> 00:14:23.379 a top tier program. And that so part of who I 00:14:23.379 --> 00:14:26.899 am is that I do have a chip on my shoulder because 00:14:26.899 --> 00:14:29.960 of all the things I just told you. And I have 00:14:29.960 --> 00:14:32.019 the mindset of I'm going to make it. I'm going 00:14:32.019 --> 00:14:33.860 to work hard to make it. So when someone tells 00:14:33.860 --> 00:14:37.159 me I can't do it. then that's kind of the challenge 00:14:37.159 --> 00:14:39.840 that I had to rise to the occasion. So I only 00:14:39.840 --> 00:14:42.519 applied to the top 10 programs, and they thought 00:14:42.519 --> 00:14:45.980 I was stupid for doing that. And a little bit 00:14:45.980 --> 00:14:47.860 of luck, right place, right time, persistence, 00:14:48.320 --> 00:14:54.000 maybe some personal skills. I landed the Children's 00:14:54.000 --> 00:14:56.799 Hospital of LA, which no one ever believed that 00:14:56.799 --> 00:15:00.159 I would ever get into. And it's a long story 00:15:00.159 --> 00:15:03.340 how that happened, but I got in. Then I wanted 00:15:03.340 --> 00:15:05.340 to go to a fellowship in pediatric emergency 00:15:05.340 --> 00:15:07.960 medicine because when I was in residency in my 00:15:07.960 --> 00:15:10.980 training, I knew that I belonged in the ER because 00:15:10.980 --> 00:15:14.100 I just found myself wanting to live in the ER. 00:15:14.299 --> 00:15:17.799 I needed to be where the action was. I loved 00:15:17.799 --> 00:15:20.240 the resuscitations. I just loved every minute 00:15:20.240 --> 00:15:22.379 of it. Didn't like the ICU because it was more 00:15:22.379 --> 00:15:25.899 like chronic care for me. I'm more of a, you 00:15:25.899 --> 00:15:27.840 know, treat them and street them kind of thing. 00:15:28.940 --> 00:15:33.200 Then I applied to one of the top pediatric ER 00:15:33.200 --> 00:15:35.779 fellowships, which is another three years after 00:15:35.779 --> 00:15:37.879 training. And everyone said, there's no way they're 00:15:37.879 --> 00:15:41.200 going to take you. It's a top program. And I 00:15:41.200 --> 00:15:44.759 ended up getting into Pittsburgh, which again, 00:15:45.000 --> 00:15:49.860 all these things, I end up along my journey meeting 00:15:49.860 --> 00:15:53.340 the best of the best. They all shaped and crafted 00:15:53.340 --> 00:16:00.720 who I am today. And it gave me a certain level 00:16:00.720 --> 00:16:06.399 of understanding, education, and know -how. So 00:16:06.399 --> 00:16:10.899 I had that confidence of who is Peter Antebi, 00:16:11.080 --> 00:16:15.139 which leads up to today, which is that I am definitely 00:16:15.139 --> 00:16:18.500 somebody now who I have a friend, Rob Warner, 00:16:18.740 --> 00:16:20.419 who used to always say about me, and I never 00:16:20.419 --> 00:16:23.940 understood this then, is that I walk to the beat 00:16:23.940 --> 00:16:28.090 of my own drum. I will tell you 100 % today that 00:16:28.090 --> 00:16:31.389 that is the line that probably truly defines 00:16:31.389 --> 00:16:36.190 me the best. Because if I believe something to 00:16:36.190 --> 00:16:40.549 be true and I can back it with data and I just 00:16:40.549 --> 00:16:43.830 inherently know that's the answer, then I will 00:16:43.830 --> 00:16:46.990 continue to march in that direction until I'm 00:16:46.990 --> 00:16:51.470 proven wrong or that I'm proven right. I won't 00:16:51.470 --> 00:16:55.539 stop moving in that direction for... these very 00:16:55.539 --> 00:17:02.000 big ideas that just pull me. I cannot pull myself 00:17:02.000 --> 00:17:05.160 away from it once I see it. And typically when 00:17:05.160 --> 00:17:08.859 I see something, it's usually years before other 00:17:08.859 --> 00:17:11.799 people even want to even talk about it. So I 00:17:11.799 --> 00:17:13.720 had to learn that about myself. That's a good 00:17:13.720 --> 00:17:16.279 thing, but it's also not a good thing because 00:17:16.279 --> 00:17:19.180 it's so far in advance that oftentimes people 00:17:19.180 --> 00:17:23.599 don't even want to engage at the time that I've, 00:17:23.900 --> 00:17:27.920 I've seen it as the truth. So these are the things, 00:17:27.920 --> 00:17:29.579 and ever since the last conversation we've had, 00:17:29.720 --> 00:17:33.660 I now know myself so well that I have to temper 00:17:33.660 --> 00:17:39.259 that based on who I'm talking to. But I also 00:17:39.259 --> 00:17:40.900 now have an audience who wants to hear those 00:17:40.900 --> 00:17:44.220 things. And so I found myself in a very interesting 00:17:44.220 --> 00:17:47.559 place now where I can understand myself so much 00:17:47.559 --> 00:17:51.730 better. That I know where to push the gas. I 00:17:51.730 --> 00:17:53.970 know where to put the brakes. I know how to message 00:17:53.970 --> 00:17:57.470 things. And at the end of the day, I see myself 00:17:57.470 --> 00:18:02.170 as inspiring other people to at least start walking 00:18:02.170 --> 00:18:05.890 in that direction. And that's kind of at least 00:18:05.890 --> 00:18:09.190 where I see myself today. Not going and holding 00:18:09.190 --> 00:18:11.450 someone's hand and saying, I'm going to change 00:18:11.450 --> 00:18:15.289 you personally, but getting the message out to 00:18:15.289 --> 00:18:17.869 people who say. I believe that guy and I'm going 00:18:17.869 --> 00:18:19.750 to start walking in that direction and do my 00:18:19.750 --> 00:18:22.329 own thing. And then I'll call him 10 years later 00:18:22.329 --> 00:18:25.130 and say, hey, it was a lecture I saw you give 00:18:25.130 --> 00:18:28.509 that made me want to think about doing that. 00:18:28.630 --> 00:18:34.289 And that's what gives me the joy today in my 00:18:34.289 --> 00:18:37.329 personal and my professional life. It's interesting 00:18:37.329 --> 00:18:39.230 because when you said, oh, you'll never get in. 00:18:39.680 --> 00:18:42.420 When I came out of the academy in Orlando and 00:18:42.420 --> 00:18:45.200 I said, I'm going down south, a number of people 00:18:45.200 --> 00:18:46.759 that said, oh, you'll never get hired down unless 00:18:46.759 --> 00:18:49.220 you're a medic and you speak Spanish. And I worked 00:18:49.220 --> 00:18:52.720 for Hialeah, the most Spanish of areas within 00:18:52.720 --> 00:18:55.940 a few months of leaving. And then when I tested 00:18:55.940 --> 00:18:58.759 in California, the Hialeah guys told me, oh, 00:18:58.819 --> 00:19:00.359 you'll never get hired out there, blah, blah, 00:19:00.440 --> 00:19:02.900 blah. And I was my whole mindset was this. OK, 00:19:03.000 --> 00:19:05.619 I just need one of the jobs. Everyone else can 00:19:05.619 --> 00:19:08.059 have the rest of them. And then now fast forward 00:19:08.059 --> 00:19:10.420 with the 24 -72 conversation, which we will, 00:19:10.480 --> 00:19:12.960 I'm sure, get into. It's the same thing. I've 00:19:12.960 --> 00:19:15.299 been talking about it for over eight years. And 00:19:15.299 --> 00:19:17.559 eight years ago, no one wanted to hear it. And 00:19:17.559 --> 00:19:20.119 now here we are. And you're sitting in literally 00:19:20.119 --> 00:19:23.079 in a county where they're about to go to it themselves. 00:19:23.299 --> 00:19:26.779 So I totally understand. And man, you have to 00:19:26.779 --> 00:19:28.640 have a thick skin at the beginning. You really 00:19:28.640 --> 00:19:32.059 do. You do. You do. And you have to be able to. 00:19:32.119 --> 00:19:34.880 So you're someone who plays the long game. Because 00:19:34.880 --> 00:19:38.019 you have something that matters to you that's 00:19:38.019 --> 00:19:40.960 so deeply rooted in who you are and that you 00:19:40.960 --> 00:19:44.920 know is right that you say, okay, I'm going to 00:19:44.920 --> 00:19:47.279 take the next five years of just shit and pain 00:19:47.279 --> 00:19:50.599 and all this negative feedback, but it's going 00:19:50.599 --> 00:19:52.819 to come full circle. Rather than the folks who 00:19:52.819 --> 00:19:56.180 are trying to make a quick buck, trying to gain 00:19:56.180 --> 00:19:58.579 popularity, more clicks, more likes, more subscribers. 00:20:00.369 --> 00:20:03.630 When that idea doesn't work, they quickly abandon 00:20:03.630 --> 00:20:05.609 it because it doesn't really have the true value 00:20:05.609 --> 00:20:08.210 or true meaning. So I think you and I both come 00:20:08.210 --> 00:20:10.670 from a place where, and maybe we will talk about 00:20:10.670 --> 00:20:13.369 the error that I made early in my career, which 00:20:13.369 --> 00:20:17.069 kind of really changed my life. And it put me 00:20:17.069 --> 00:20:18.750 on this mission of I have to fix that problem. 00:20:18.930 --> 00:20:22.970 The same thing happened to you. So I do see value 00:20:22.970 --> 00:20:28.029 in having something. that impacted you in your 00:20:28.029 --> 00:20:31.509 life that's so strong, that blends in with who 00:20:31.509 --> 00:20:33.450 you are as a person, your background, how you 00:20:33.450 --> 00:20:35.730 were raised, that ends up putting you on this 00:20:35.730 --> 00:20:38.390 trajectory that your life at the end of the day 00:20:38.390 --> 00:20:41.390 does have great meaning. And I think that's what 00:20:41.390 --> 00:20:43.630 everybody should seek is having a life that's 00:20:43.630 --> 00:20:46.329 worth living. Absolutely. Well, let's talk about 00:20:46.329 --> 00:20:49.250 that now. Explain that era and how that did have 00:20:49.250 --> 00:20:53.490 this ripple effect. Yeah, so I trained in LA 00:20:53.490 --> 00:20:55.630 Children's and Pittsburgh Children's, two of 00:20:55.630 --> 00:20:58.809 the top 10 children's hospitals, and I was never 00:20:58.809 --> 00:21:04.769 trained on using a length -based tape to dose 00:21:04.769 --> 00:21:08.210 medications. Why? Because at these children's 00:21:08.210 --> 00:21:14.049 hospitals, someone had taken this idea of creating 00:21:14.049 --> 00:21:17.309 their own manual or booklet, if you will, that 00:21:17.309 --> 00:21:20.940 had custom dosing. based on the age of the child 00:21:20.940 --> 00:21:25.819 or the weight. The age gets you to the weight, 00:21:25.880 --> 00:21:28.400 or if you have the actual weight, then I just 00:21:28.400 --> 00:21:30.279 need to turn to a page that has the actual weight. 00:21:30.759 --> 00:21:33.039 So what I learned in LA and in Pittsburgh is 00:21:33.039 --> 00:21:36.579 that we just use age. And it was really mainly 00:21:36.579 --> 00:21:39.019 in Pittsburgh. One of my mentors, Robert Hickey, 00:21:39.119 --> 00:21:42.880 Bob Hickey, would walk into a code room and he 00:21:42.880 --> 00:21:45.680 said, we have a five -minute ETA cardiac arrest, 00:21:45.839 --> 00:21:48.119 two -year -old. He says, okay, two -year -old, 00:21:48.180 --> 00:21:50.549 that's all I need. The kid weighs 12 kilos. Like 00:21:50.549 --> 00:21:53.430 he would just hear the age. And then next thing 00:21:53.430 --> 00:21:56.089 you know, we were off and running. Fast forward 00:21:56.089 --> 00:22:00.069 2005, I'm in Joe DiMaggio in tertiary children's 00:22:00.069 --> 00:22:01.869 hospital, level one trauma center, the whole 00:22:01.869 --> 00:22:07.869 nine yards. One of my first calls, like my first 00:22:07.869 --> 00:22:10.289 bad case was a kid who comes in with anaphylaxis, 00:22:10.309 --> 00:22:12.329 four -year -old girl. She was in room number 00:22:12.329 --> 00:22:15.549 four. I'll never forget the nurse. She runs out 00:22:15.549 --> 00:22:18.089 of the room and she says, and Tevi, get in here 00:22:18.089 --> 00:22:21.930 now. This girl's in severe anaphylaxis. And now 00:22:21.930 --> 00:22:25.250 I'm a new doctor. I have no idea about dosing 00:22:25.250 --> 00:22:29.029 or anything at this point. And so she has this 00:22:29.029 --> 00:22:32.089 Braslo tape with her. She literally has it in 00:22:32.089 --> 00:22:34.509 her hand. And I'm looking at it. I'm like, I 00:22:34.509 --> 00:22:38.710 have no idea what that is. So she points to the 00:22:38.710 --> 00:22:43.930 box. It was the blue box. And she points to epi 00:22:43.930 --> 00:22:46.950 1 to 1 ,000. She's like, here. And it said 2 00:22:46.950 --> 00:22:51.200 .1 ml. I said, let's do it. Let's give it. Now, 00:22:51.220 --> 00:22:54.759 I didn't read. The writing right above it said 00:22:54.759 --> 00:22:58.839 resuscitation. And the epi 1 to 1 ,000, it had 00:22:58.839 --> 00:23:02.000 two little letters afterward that says ET, endotracheal 00:23:02.000 --> 00:23:05.400 tube, meaning that that was the dose for epi 00:23:05.400 --> 00:23:07.440 if you couldn't get an IV and then you would 00:23:07.440 --> 00:23:10.740 give 1 to 10 ,000. You would give 1 to 1 ,000 00:23:10.740 --> 00:23:13.279 through the ET tube for cardiac arrest. We don't 00:23:13.279 --> 00:23:15.740 do that anymore because we have the IO, so that's 00:23:15.740 --> 00:23:18.049 kind of a thing of the past. So I just said, 00:23:18.069 --> 00:23:20.369 go ahead and give that. So she gave. Instead 00:23:20.369 --> 00:23:23.910 of 0 .21 ml IM, which would have been the right 00:23:23.910 --> 00:23:25.869 dose, which is not even listed on the Braslow 00:23:25.869 --> 00:23:32.569 tape, we gave 2 .1 ml IM, tenfold overdose. The 00:23:32.569 --> 00:23:34.569 girl's heart rate and blood pressure went through 00:23:34.569 --> 00:23:37.190 the roof. I mean, her wheezing went away and 00:23:37.190 --> 00:23:41.170 her eyes got better. But the mom looks at me 00:23:41.170 --> 00:23:43.829 and she's like, hey, doctor, why is this alarm 00:23:43.829 --> 00:23:46.000 ringing? I'm like, I'm just going to keep muting 00:23:46.000 --> 00:23:48.059 it, muting, muting. Finally, the nurse comes 00:23:48.059 --> 00:23:51.380 in and she's like, hey, this is like, her blood 00:23:51.380 --> 00:23:54.599 pressure is really high. You know what? Let's 00:23:54.599 --> 00:23:56.640 just get her to the ICU. She spends the night 00:23:56.640 --> 00:24:01.180 in the ICU. I then figure out that I ended up 00:24:01.180 --> 00:24:03.279 giving a tenfold. It wasn't apparent very quickly 00:24:03.279 --> 00:24:05.519 to me, right? Because I just said, here's the 00:24:05.519 --> 00:24:07.220 dose, give it. And I didn't know any better, 00:24:07.319 --> 00:24:11.759 right? I had to figure that out. So now I'm coming 00:24:11.759 --> 00:24:13.980 to work. The next day, and I'm like, oh, God, 00:24:14.039 --> 00:24:16.940 this is not good. Another call, which I don't 00:24:16.940 --> 00:24:19.700 talk about often, which is a 7 a .m. call. I 00:24:19.700 --> 00:24:22.240 get to work at 7 a .m., and we get that dead 00:24:22.240 --> 00:24:25.759 baby call, infant, two -month -old. A mom had 00:24:25.759 --> 00:24:27.980 rolled over at night and slept on the kid, suffocated 00:24:27.980 --> 00:24:30.140 him to death. So this kid comes in already stiff 00:24:30.140 --> 00:24:33.799 and dead, right? But again, kid's dead. They're 00:24:33.799 --> 00:24:37.039 doing CPR. I'm now at the head of the bed. They 00:24:37.039 --> 00:24:38.940 bring the child in. The mother's standing right 00:24:38.940 --> 00:24:41.970 there. And now because someone had been stealing 00:24:41.970 --> 00:24:45.430 the Braslo tapes, they decided to encase it in 00:24:45.430 --> 00:24:52.289 wood. James, imagine I'm holding a six foot two 00:24:52.289 --> 00:24:57.509 by four at the head of the bed. And now I'm thinking 00:24:57.509 --> 00:24:59.029 to myself, what am I supposed to do with this 00:24:59.029 --> 00:25:01.309 thing? And the nurses are like, the doses are 00:25:01.309 --> 00:25:03.910 right there. And now I'm looking and I'm like, 00:25:03.990 --> 00:25:07.130 are you freaking kidding me? They really want 00:25:07.130 --> 00:25:10.289 me to hold this thing up. Like if I turned, I 00:25:10.289 --> 00:25:13.490 would have killed two people. And so anyway, 00:25:13.630 --> 00:25:16.130 that code didn't go well. Fortunately for me 00:25:16.130 --> 00:25:19.509 anyway, my mental state, this kid was already 00:25:19.509 --> 00:25:22.230 dead. We knew that because the kid was already 00:25:22.230 --> 00:25:26.829 in rigor. Okay. But now you understand where 00:25:26.829 --> 00:25:29.630 my mindset is. And like, I'm screwed here. Like 00:25:29.630 --> 00:25:32.470 I'm in a place where it's not Pittsburgh, ivory 00:25:32.470 --> 00:25:35.829 tower. It's not LA, ivory tower. I'm in a tertiary 00:25:35.829 --> 00:25:38.890 community hospital. where the people around me, 00:25:38.930 --> 00:25:40.329 quite frankly, have no idea what they're doing. 00:25:41.630 --> 00:25:45.049 And so that led me into this whole thing of, 00:25:45.150 --> 00:25:48.789 I call Bob Hickey in Pittsburgh. I do a lot of 00:25:48.789 --> 00:25:53.210 research. I asked Bob, hey, weren't you using 00:25:53.210 --> 00:25:55.630 age? He says, yeah, I only use age. And I said, 00:25:55.730 --> 00:25:57.990 well, why isn't the rest of the world using age? 00:25:58.150 --> 00:26:00.589 And hey, Bob, aren't you the second name in the 00:26:00.589 --> 00:26:03.509 PALS booklet? Didn't you help write? He's like, 00:26:03.609 --> 00:26:05.829 yes, I did. Why didn't you actually have ages 00:26:05.829 --> 00:26:09.099 in PALS? That's a long story, he says to me. 00:26:09.359 --> 00:26:12.960 I said, Bob, I'm ready for a long story. Anyway, 00:26:13.079 --> 00:26:14.539 I'm not going to give that whole explanation, 00:26:14.619 --> 00:26:17.160 but it's very interesting. But long story short, 00:26:17.339 --> 00:26:20.240 I then went and took a piece of paper. I wrote 00:26:20.240 --> 00:26:24.460 down all the ages, 1, 2, 3, 4, 5, 6, 7, 8. I 00:26:24.460 --> 00:26:26.700 started writing down what drugs I would need 00:26:26.700 --> 00:26:29.440 during a code. I started looking at formulas. 00:26:30.339 --> 00:26:33.759 And I finally, after a few pieces of blank paper, 00:26:33.859 --> 00:26:37.980 I got to 1, 3, 5, 7, and 9. Because I can count 00:26:37.980 --> 00:26:41.240 those on one hand. And then through all these 00:26:41.240 --> 00:26:45.279 formulas, I got to 10, 15, 20, 25, 30 kilograms 00:26:45.279 --> 00:26:50.099 for those respective ages. I calculated then 00:26:50.099 --> 00:26:53.140 all the drugs. I had like five, ended up with 00:26:53.140 --> 00:26:55.839 eight drugs. And when I looked at the math, when 00:26:55.839 --> 00:26:57.819 I did the math and I converted it to a volume, 00:26:57.980 --> 00:27:00.319 so a one -year -old, let's example, is 10 kilos. 00:27:00.900 --> 00:27:03.420 I figured out it was one ml of epi, one to 10 00:27:03.420 --> 00:27:07.579 ,000. I filled up the spreadsheet with just MLs. 00:27:07.960 --> 00:27:11.000 Every drug was just in volume and a pattern, 00:27:11.019 --> 00:27:14.279 like not just hit me in the face, it punched 00:27:14.279 --> 00:27:16.839 me in the face. Well, I could look at this thing 00:27:16.839 --> 00:27:19.619 and I said, wait a minute, just give me the age 00:27:19.619 --> 00:27:21.980 now. I'll convert it to a weight. And from that 00:27:21.980 --> 00:27:25.259 weight, I can now figure out the volume of let's 00:27:25.259 --> 00:27:28.319 start off with these five drugs. It was like 00:27:28.319 --> 00:27:32.440 a miracle. And I started going into the code 00:27:32.440 --> 00:27:35.980 room. And now I had my head up high and I would 00:27:35.980 --> 00:27:38.319 say, how old is the kid coming in? Three years 00:27:38.319 --> 00:27:42.140 old. Okay. 1 .5 cc's of epi. If he needs amiodarone, 00:27:42.200 --> 00:27:45.259 that's 1 .5 cc's of that. Back then we used atropine. 00:27:45.279 --> 00:27:49.460 That's three cc's. I just knew everything. The 00:27:49.460 --> 00:27:52.240 dextrose was 30. And all of a sudden the nurses 00:27:52.240 --> 00:27:55.539 came to me and said, something has happened to 00:27:55.539 --> 00:27:59.599 you. And then, you know, my confidence was booming, 00:27:59.640 --> 00:28:02.519 but I was so embarrassed. This is the important 00:28:02.519 --> 00:28:06.180 part. I was so ashamed. I never told anybody 00:28:06.180 --> 00:28:09.619 what I was doing or how I did it. And there's 00:28:09.619 --> 00:28:11.700 a book I read recently. I don't think it's on 00:28:11.700 --> 00:28:13.940 my bookshelf here. I think it's at home where 00:28:13.940 --> 00:28:18.160 it talks about medical errors and the shame that 00:28:18.160 --> 00:28:21.420 comes along with it and the embarrassment, which 00:28:21.420 --> 00:28:24.559 I felt and I never wanted to tell anybody for 00:28:24.559 --> 00:28:28.059 years until a nurse came to me and said, hey, 00:28:28.099 --> 00:28:31.059 Pete, listen, you're giving a talk. Next week, 00:28:31.059 --> 00:28:33.859 I think it was drowning or pediatric shock. She's 00:28:33.859 --> 00:28:36.140 like, can you do me a favor? Just teach everybody 00:28:36.140 --> 00:28:39.799 whatever trick you have memorized or learned. 00:28:39.880 --> 00:28:43.359 I said, fine. 200 people in the audience, paramedics, 00:28:43.359 --> 00:28:47.539 doctors, nurses. I gave this talk. And at the 00:28:47.539 --> 00:28:51.799 end of my talk, 50 people lined up. And I'm like, 00:28:51.900 --> 00:28:56.140 whoa, was the talk that good? I'm a new speaker. 00:28:56.299 --> 00:28:57.480 I didn't think I was that good of a speaker. 00:28:58.140 --> 00:29:00.609 And they said. no, no, no, we don't care about 00:29:00.609 --> 00:29:03.250 this drowning talk. We want your last two slides. 00:29:04.130 --> 00:29:07.430 I said, what? And I came home, I never forget, 00:29:07.470 --> 00:29:10.190 I came home to my wife and said, Allison, I said, 00:29:10.250 --> 00:29:12.430 I got to tell you what just happened today. And 00:29:12.430 --> 00:29:15.329 she's like a very process oriented. She can do 00:29:15.329 --> 00:29:17.730 anything and she can help me figure out what's 00:29:17.730 --> 00:29:20.589 in my head. She says, well, why don't you make 00:29:20.589 --> 00:29:22.470 a little card, a little badge buddy out of it? 00:29:22.849 --> 00:29:26.029 So I never forget. I'm on my computer. I made 00:29:26.029 --> 00:29:28.529 a little image. I went to FedEx Kinko's at the 00:29:28.529 --> 00:29:32.049 time. I laminated like 20 of them, brought them 00:29:32.049 --> 00:29:35.309 to work the next day. If I tell you, James, within 00:29:35.309 --> 00:29:39.369 10 minutes, they were gone. And I came home. 00:29:39.390 --> 00:29:41.829 I'm like, hon, you got to understand what's going 00:29:41.829 --> 00:29:45.230 on here. And then because of that first lecture, 00:29:45.369 --> 00:29:47.650 another lecture request, and then another lecture. 00:29:47.710 --> 00:29:49.430 And then I got a call from Nevada and then from 00:29:49.430 --> 00:29:52.410 Georgia. Hey, you guys need anything from me? 00:29:52.589 --> 00:29:55.019 Yeah, we heard that you give a talk on. medication 00:29:55.019 --> 00:29:59.680 dosing using your hand. I'm like, really? Long 00:29:59.680 --> 00:30:02.000 story short, I started printing out these cards 00:30:02.000 --> 00:30:06.299 a hundred at a time. Bring them to the ER, gone. 00:30:06.980 --> 00:30:10.420 Bring them to a lecture, gone. And then I started 00:30:10.420 --> 00:30:11.859 getting phone calls from around the country. 00:30:12.359 --> 00:30:14.940 Hey, because I had my email or we had something 00:30:14.940 --> 00:30:16.380 on the back that you can get in touch with me. 00:30:16.940 --> 00:30:19.519 I said, hey, we just saved a kid on the highway 00:30:19.519 --> 00:30:22.440 thanks to your card. I'm like, are you kidding 00:30:22.440 --> 00:30:25.049 me? So anyway. This is not becoming therapy for 00:30:25.049 --> 00:30:30.170 me because I had made those mistakes. And then 00:30:30.170 --> 00:30:31.829 the mistake that I made that I should probably 00:30:31.829 --> 00:30:34.490 tell you about, which I tell very few people, 00:30:34.609 --> 00:30:37.910 is a mistake where an actual girl did die because 00:30:37.910 --> 00:30:40.910 of my error. And it wasn't an error of an overdose 00:30:40.910 --> 00:30:43.690 or what I call an error of commission. It was 00:30:43.690 --> 00:30:46.150 an error of omission. It was a seven -year -old 00:30:46.150 --> 00:30:49.549 girl who was septic who I gave everything except 00:30:49.549 --> 00:30:53.569 the vasopressor because I didn't know the LevaFed 00:30:53.569 --> 00:30:56.410 dose. And I knew that if I asked a nurse for 00:30:56.410 --> 00:31:00.529 LevaFed, that she would ask me, what dose? How 00:31:00.529 --> 00:31:01.789 do you want to run it? How do you want to mix 00:31:01.789 --> 00:31:04.509 that? So I went outside the room and I whispered 00:31:04.509 --> 00:31:07.190 to a nurse, get me LevaFed. And the first thing 00:31:07.190 --> 00:31:10.289 she said to me is, what dose? And I'm like, oh 00:31:10.289 --> 00:31:13.190 God. So she ended up calling Steve in the pharmacy, 00:31:13.410 --> 00:31:16.130 third floor. In the meantime, this girl's ready 00:31:16.130 --> 00:31:19.130 for the ICU. We put the monitor on the bed. We 00:31:19.130 --> 00:31:21.490 start rolling her up. She's like not doing well. 00:31:21.930 --> 00:31:24.750 still hypotensive, tachycardic. She had gotten 00:31:24.750 --> 00:31:26.470 fluid, you got an antibiotic, gotten blood work, 00:31:26.549 --> 00:31:29.089 all that stuff, the regular stuff. But I needed 00:31:29.089 --> 00:31:32.630 to give her levophed and I didn't. So I get up 00:31:32.630 --> 00:31:36.049 to the ICU, the doors open, the ICU doctor, his 00:31:36.049 --> 00:31:38.970 name is Gerald, not a nice guy. He's a nice guy 00:31:38.970 --> 00:31:42.430 usually, but like, you know, he expects you to 00:31:42.430 --> 00:31:44.890 do the right thing. He looks at me, he says, 00:31:44.910 --> 00:31:48.349 Pete, where's the presser? And I said. I said, 00:31:48.369 --> 00:31:51.269 Gerald, I ordered it. He looks at me and says, 00:31:51.390 --> 00:31:55.170 Pete, get out of here. And this is in front of 00:31:55.170 --> 00:31:58.049 everybody, right? That girl ended up dying the 00:31:58.049 --> 00:32:02.430 next day, right? So as I sit here today, that 00:32:02.430 --> 00:32:06.309 death was my fault, period, end of story. It's 00:32:06.309 --> 00:32:10.269 hard for me to tell that story today. That'll 00:32:10.269 --> 00:32:12.789 live with me forever, unfortunately. And the 00:32:12.789 --> 00:32:17.079 worst part about it is that I ended up in public 00:32:17.079 --> 00:32:19.059 supermarkets, you know, Publix, you're from Florida. 00:32:19.740 --> 00:32:22.079 And I'm at the deli counter. This is years later, 00:32:22.240 --> 00:32:24.420 three, four years later. And this is probably 00:32:24.420 --> 00:32:28.119 10, 12 years ago, like just a long time ago. 00:32:29.259 --> 00:32:31.660 I'm at the deli counter. And there's a lot of 00:32:31.660 --> 00:32:33.299 people at the deli counter waiting to give their 00:32:33.299 --> 00:32:36.980 order. And I look to my right, and I lock eyes 00:32:36.980 --> 00:32:40.660 with this lady. And it was kind of like, she 00:32:40.660 --> 00:32:43.859 saw me, I saw her. It took us a split second 00:32:43.859 --> 00:32:47.589 to figure out who each other was. Once she figured 00:32:47.589 --> 00:32:50.609 out who it was, you know what she did? She turns 00:32:50.609 --> 00:32:53.289 around and she beelines out of the store. That's 00:32:53.289 --> 00:33:04.589 what she did. So I never saw her again, but she's 00:33:04.589 --> 00:33:08.210 living there today knowing that what I didn't 00:33:08.210 --> 00:33:11.390 do may have led to her daughter's death. I think 00:33:11.390 --> 00:33:14.640 it did. Okay, let's be honest. I didn't give 00:33:14.640 --> 00:33:18.119 the right care at the time. And I know today 00:33:18.119 --> 00:33:20.859 that that will live with me forever, unfortunately. 00:33:21.119 --> 00:33:25.220 So what is driving me today are those errors 00:33:25.220 --> 00:33:27.880 that I made initially, the error that ended up 00:33:27.880 --> 00:33:30.220 causing the life of this little seven -year -old 00:33:30.220 --> 00:33:37.079 girl. And my purpose today is not to shine light 00:33:37.079 --> 00:33:40.119 on myself at all. It's to help the next person 00:33:40.119 --> 00:33:42.859 who's going to be in that situation. who's going 00:33:42.859 --> 00:33:47.319 to wonder, can I do what I'm supposed to do and 00:33:47.319 --> 00:33:50.000 actually give the right drug? Will I not omit 00:33:50.000 --> 00:33:54.359 a medication that a child needs because I, for 00:33:54.359 --> 00:33:55.980 some reason, don't know the dose or can't do 00:33:55.980 --> 00:34:00.099 the math? And that's what 100 % drives me today 00:34:00.099 --> 00:34:02.680 is to make sure that the next person, whether 00:34:02.680 --> 00:34:05.099 you're a paramedic, a critical care paramedic, 00:34:05.099 --> 00:34:09.639 an EMT, a nurse, a doctor, and I can tell you, 00:34:09.659 --> 00:34:12.320 I can tell you because now we're in We're in 00:34:12.320 --> 00:34:15.519 all 50 states. We have 160 ,000 active users. 00:34:15.719 --> 00:34:17.840 We're in the biggest hospitals in America. People 00:34:17.840 --> 00:34:22.400 call me and they say to me that, and these are 00:34:22.400 --> 00:34:25.800 like really smart, amazing people who say that 00:34:25.800 --> 00:34:29.159 we're not for the dosing tool that you provided 00:34:29.159 --> 00:34:32.179 us, the app. I never would have been able to 00:34:32.179 --> 00:34:35.920 do it, right? And then the worst part is the 00:34:35.920 --> 00:34:40.150 hospitals who call us today. I say, not me anymore, 00:34:40.269 --> 00:34:44.789 but we say, so what made you call us? And 100 00:34:44.789 --> 00:34:47.650 out of 100 times it's, we had a death. We just 00:34:47.650 --> 00:34:49.829 had a death. Now, they don't give us all the 00:34:49.829 --> 00:34:52.550 details. Or they say we had a bad outcome. And 00:34:52.550 --> 00:34:54.469 we know what the bad outcome is. The bad outcome 00:34:54.469 --> 00:34:57.030 is they did exactly what I did. Either gave the 00:34:57.030 --> 00:34:58.570 wrong drug or they didn't give a drug at all. 00:34:58.670 --> 00:35:01.750 They delayed care. They delayed diagnosis. And 00:35:01.750 --> 00:35:04.610 they know that they screwed up. And now they 00:35:04.610 --> 00:35:08.940 need help. And so. I could tell you, James, it's 00:35:08.940 --> 00:35:12.239 happening every single day in every single agency, 00:35:12.340 --> 00:35:14.460 in every single hospital. There are kids that 00:35:14.460 --> 00:35:19.440 are having bad outcomes today because of an issue 00:35:19.440 --> 00:35:23.619 that I had and that we all have. And that's my 00:35:23.619 --> 00:35:25.719 goal is to try and fix that. So long answer, 00:35:25.780 --> 00:35:28.840 but that's kind of like. I went deep down into 00:35:28.840 --> 00:35:31.659 where it hurts to give you that one. Well, I 00:35:31.659 --> 00:35:33.760 appreciate your courageous vulnerability. I mean, 00:35:33.780 --> 00:35:36.559 this is the moral injury that we all deal with. 00:35:36.679 --> 00:35:38.760 And I think even when you take your job seriously 00:35:38.760 --> 00:35:41.599 and you've trained diligently, there are days, 00:35:41.699 --> 00:35:43.440 I mean, let's just go back to sleep deprivation 00:35:43.440 --> 00:35:45.559 for a moment, which your community suffered from, 00:35:45.639 --> 00:35:47.659 which my community suffered from. There's times 00:35:47.659 --> 00:35:49.000 where on a good day, you would have remembered 00:35:49.000 --> 00:35:51.519 the dose. And that day you can't for love nor 00:35:51.519 --> 00:35:53.960 money. And so this is why what you came up with 00:35:53.960 --> 00:35:58.090 is so important. And those, you know, the algorithms, 00:35:58.610 --> 00:36:01.250 the megacodes, all these things that we go through, 00:36:01.409 --> 00:36:03.690 if you think about it for a moment, those are 00:36:03.690 --> 00:36:07.130 in an ideal situation. If everything goes correctly, 00:36:07.349 --> 00:36:08.969 this is what it will look like. Well, we all 00:36:08.969 --> 00:36:11.869 know that many times where it doesn't go correctly, 00:36:12.010 --> 00:36:13.789 whether it's the location of the patient or you 00:36:13.789 --> 00:36:16.510 can't get an IV and the IO drill doesn't work 00:36:16.510 --> 00:36:18.250 for some reason or whatever the thing is. And 00:36:18.250 --> 00:36:20.150 all of a sudden, you know, there's this moral 00:36:20.150 --> 00:36:22.909 injury now. What if, what if, what if? That being 00:36:22.909 --> 00:36:26.889 said, though, just. staying on this kind of loss 00:36:26.889 --> 00:36:29.409 that you had, once this little girl got to the 00:36:29.409 --> 00:36:32.929 ICU, I'm assuming she was put on a vasopressor 00:36:32.929 --> 00:36:35.150 then? Yeah. Okay. She was put on a vasopressor 00:36:35.150 --> 00:36:38.369 and she was intubated. Okay. So it wasn't solely 00:36:38.369 --> 00:36:41.010 just that emission. As much as it haunts you, 00:36:41.570 --> 00:36:44.829 that drug was put in place and she was given 00:36:44.829 --> 00:36:47.829 that opportunity to overcome the challenge that 00:36:47.829 --> 00:36:51.989 she had. Yes. Yes. But I know so much more now 00:36:51.989 --> 00:36:57.039 than I did then to know that The speed to treatment 00:36:57.039 --> 00:37:01.360 is what saves lives. Okay. And if I could take 00:37:01.360 --> 00:37:02.920 a little detour to what happened to me yesterday. 00:37:03.099 --> 00:37:05.780 Please. Okay. Which was maybe the most incredible 00:37:05.780 --> 00:37:09.800 experience I've had in the least, in the last 00:37:09.800 --> 00:37:12.460 decade. Okay. Clinical. Because, you know, I 00:37:12.460 --> 00:37:14.800 don't work in the ER anymore. I strictly work 00:37:14.800 --> 00:37:19.099 in EMS. So I was riding out yesterday in Palm 00:37:19.099 --> 00:37:22.559 Beach Gardens. And we get a call for cardiac 00:37:22.559 --> 00:37:25.559 arrest. A guy got stung by 10 hornets. And he's 00:37:25.559 --> 00:37:27.480 in cardiac arrest. He's a guy who's a landscaper. 00:37:28.460 --> 00:37:32.039 And as soon as these hornets get to him, he starts 00:37:32.039 --> 00:37:34.760 running. And he collapses like 100 feet later. 00:37:34.900 --> 00:37:37.079 Now he's foaming at the mouth when the bystander 00:37:37.079 --> 00:37:39.980 gets to him. The CPR calls 911. Cop gets there. 00:37:40.019 --> 00:37:43.900 The CPR. We get there. Meaning engine gets there 00:37:43.900 --> 00:37:46.539 first. Rescue gets there second. EMS captain 00:37:46.539 --> 00:37:49.809 and myself get there third. By the time we get 00:37:49.809 --> 00:37:51.670 there, the guy already has a proximal humeral 00:37:51.670 --> 00:37:55.650 IO in and no pulse, can't get a blood pressure, 00:37:55.690 --> 00:37:57.110 but he's breathing on his own. So he's got some 00:37:57.110 --> 00:38:00.250 sort of circulatory flow going. He's clearly 00:38:00.250 --> 00:38:04.869 not in cardiac arrest, but he's in severe anaphylaxis, 00:38:04.869 --> 00:38:07.510 like severe. Can't hear any breath sounds, horrible. 00:38:08.090 --> 00:38:11.110 This is a moment where I'm like, okay, what we 00:38:11.110 --> 00:38:14.989 do now in the next three to 10 minutes is either 00:38:14.989 --> 00:38:19.570 going to make or break this guy. And I'm linking 00:38:19.570 --> 00:38:22.369 this back to this other girl who was delayed 00:38:22.369 --> 00:38:27.170 by 30 minutes, an hour maybe. And why is that 00:38:27.170 --> 00:38:29.989 important? Because this guy, within literally 00:38:29.989 --> 00:38:32.329 10 minutes, because from the time we were on 00:38:32.329 --> 00:38:35.090 scene, we gave a bunch of push press for epi, 00:38:35.130 --> 00:38:40.130 Benadryl, Salimedrol, Abuterol. And then I had 00:38:40.130 --> 00:38:42.030 the MS captain take out the LifeFlow, which is 00:38:42.030 --> 00:38:45.760 basically the rapid infuser. And I'm like, I'm 00:38:45.760 --> 00:38:47.719 not screwing this one up. We're giving this guy 00:38:47.719 --> 00:38:49.820 a leader right now before we even get to the 00:38:49.820 --> 00:38:52.420 hospital. And if I tell you, this guy went from 00:38:52.420 --> 00:38:56.880 effectively dead, not looking around, not moving, 00:38:57.079 --> 00:39:00.099 barely breathing, to literally, James, when we 00:39:00.099 --> 00:39:02.559 got outside of the, right when we pulled him 00:39:02.559 --> 00:39:05.820 out of the ambulance, we're at the ambulance 00:39:05.820 --> 00:39:09.940 bay, the guy opens his eyes, and I swear to God, 00:39:10.039 --> 00:39:14.369 he smiles and he gives us a thumbs up. If this 00:39:14.369 --> 00:39:17.389 was on video, you would think it was almost like 00:39:17.389 --> 00:39:21.070 a joke, like a movie. And the whole ER is waiting 00:39:21.070 --> 00:39:24.309 for a cardiac arrest from anaphylaxis from hornets. 00:39:24.849 --> 00:39:28.690 And we set the guy up. We roll into the emergency 00:39:28.690 --> 00:39:31.570 department. And people are looking at him. And 00:39:31.570 --> 00:39:33.090 he's looking around. And he starts answering 00:39:33.090 --> 00:39:37.909 questions. So I know that I could have done better 00:39:37.909 --> 00:39:42.079 on that girl many years ago. Yes, the girl got 00:39:42.079 --> 00:39:44.059 everything she needed, but she needed it now. 00:39:44.280 --> 00:39:47.659 She didn't need it from Gerald an hour later, 00:39:47.800 --> 00:39:51.219 right? If we wouldn't have done what we did for 00:39:51.219 --> 00:39:53.519 this guy yesterday, you know what would have 00:39:53.519 --> 00:39:56.039 happened to him? We got to the ER with barely 00:39:56.039 --> 00:39:58.619 any pressure. Somebody would have had the grand 00:39:58.619 --> 00:40:01.480 idea of intubating him, paralyzing him, taking 00:40:01.480 --> 00:40:03.480 away his cardiac output. He would have arrested. 00:40:04.190 --> 00:40:06.610 His lungs were so tight. It would have been overbagging 00:40:06.610 --> 00:40:09.030 and popping pneumos. He would have died. This 00:40:09.030 --> 00:40:11.710 guy would have died. I'm sure of it. I'm sure 00:40:11.710 --> 00:40:15.150 of it. My team did such an amazing job, right? 00:40:15.630 --> 00:40:18.869 But it's because we knew what we had to do and 00:40:18.869 --> 00:40:22.730 we did it. And if this guy yesterday would have 00:40:22.730 --> 00:40:26.289 died, that would have been a grenade to all the 00:40:26.289 --> 00:40:28.010 people who were there in the back of that ambulance 00:40:28.010 --> 00:40:32.139 yesterday. Um, so what, what we do matters and 00:40:32.139 --> 00:40:36.019 what I did many years ago matter too. So no one's 00:40:36.019 --> 00:40:38.739 going to convince me that I, that the girl ended 00:40:38.739 --> 00:40:40.780 up getting the right, no, she didn't. She, she 00:40:40.780 --> 00:40:43.739 needed proper treatment from me and she didn't 00:40:43.739 --> 00:40:46.219 get it, period. And that's, that's just, I have 00:40:46.219 --> 00:40:48.760 to live with that. Right. And I'm, and, and the 00:40:48.760 --> 00:40:51.340 fact that I'm, I'm telling people the story today 00:40:51.340 --> 00:40:54.119 is a big improvement for me because I never want 00:40:54.119 --> 00:40:56.559 to, I never wanted to tell that story. Right. 00:40:56.860 --> 00:40:59.610 But now I feel like. I need to tell that story. 00:40:59.809 --> 00:41:02.090 It's good for me. And it's good for the next 00:41:02.090 --> 00:41:05.190 person who thinks that, like you had mentioned, 00:41:05.530 --> 00:41:09.670 like who in the world should be doing math when 00:41:09.670 --> 00:41:11.670 there's stress involved? If you read Daniel Kahneman's 00:41:11.670 --> 00:41:15.550 book, Thinking Fast and Slow, he proves that 00:41:15.550 --> 00:41:18.289 no one can do math under pressure. But we have 00:41:18.289 --> 00:41:22.630 paramedic schools today who will fail you if 00:41:22.630 --> 00:41:25.489 you can't do the rule of sixes or the clock rule, 00:41:25.570 --> 00:41:28.030 whatever some stupid thing someone created. And 00:41:28.030 --> 00:41:29.670 that's what they're pushing today in paramedic 00:41:29.670 --> 00:41:32.210 schools around this country, which is causing 00:41:32.210 --> 00:41:34.929 the mental health, which is causing these deaths, 00:41:35.090 --> 00:41:37.670 which is causing the suicides. It's all related, 00:41:37.909 --> 00:41:41.349 all of it. Absolutely. Well, I remember when, 00:41:41.389 --> 00:41:43.590 I think it was at Orange County, when I was introduced 00:41:43.590 --> 00:41:45.829 to Hand Heavy, and that was before the app at 00:41:45.829 --> 00:41:48.369 that point, but you had the booklet and obviously, 00:41:48.590 --> 00:41:50.329 you know, all the, I think it was the different 00:41:50.329 --> 00:41:52.969 pouches with the different colored, you know, 00:41:52.969 --> 00:41:55.889 for each child and each weight. So talk to me 00:41:55.889 --> 00:41:57.670 about where you are today. We'll stay on Hand 00:41:57.670 --> 00:41:59.889 Heavy for a moment. What are the products like 00:41:59.889 --> 00:42:05.190 in 2025? Yeah, it's really significantly improved 00:42:05.190 --> 00:42:08.820 because remember back then it was, listen, I 00:42:08.820 --> 00:42:11.139 think that the most important thing that we do 00:42:11.139 --> 00:42:13.840 and that we've done from the very beginning, 00:42:14.079 --> 00:42:17.539 which now I realize why people don't do this, 00:42:17.659 --> 00:42:20.920 is because we've committed to customization, 00:42:21.440 --> 00:42:24.179 what I call extreme customization. Meaning that 00:42:24.179 --> 00:42:26.840 at Orange County, you have a certain set of drugs 00:42:26.840 --> 00:42:29.320 and you have a protocol. And the protocol has 00:42:29.320 --> 00:42:32.059 maybe the same drug for three different things. 00:42:32.199 --> 00:42:33.840 And those three different things may have three 00:42:33.840 --> 00:42:36.179 different routes and three different doses. So 00:42:36.179 --> 00:42:41.369 the variables... that happen in every organization, 00:42:41.809 --> 00:42:43.789 whether it be an EMS organization or a hospital 00:42:43.789 --> 00:42:48.469 or a flight crew, there's so many variables. 00:42:48.710 --> 00:42:51.309 And in order to take all those variables and 00:42:51.309 --> 00:42:56.389 actually get it 100 % accurate and correct, that 00:42:56.389 --> 00:42:59.670 takes like a couple of months. So now I have 00:42:59.670 --> 00:43:02.530 a whole team of pharmacists, critical care medics, 00:43:02.570 --> 00:43:06.909 nurses, who basically take that agency and we 00:43:06.909 --> 00:43:10.010 say, We're going to do 80 % of this, but we're 00:43:10.010 --> 00:43:11.329 still going to need some skin in the game. We 00:43:11.329 --> 00:43:14.309 need you to kind of give us people who are going 00:43:14.309 --> 00:43:16.090 to tell us what your concentrations are, who 00:43:16.090 --> 00:43:18.769 are going to be accurate so that we can create 00:43:18.769 --> 00:43:22.730 an app that has accuracy. So that's something 00:43:22.730 --> 00:43:26.429 that still no one else today even wants to do. 00:43:26.789 --> 00:43:28.670 There are people who are trying it that are failing 00:43:28.670 --> 00:43:30.829 miserably because there are a couple of guys 00:43:30.829 --> 00:43:32.909 on a computer and they're telling the EMS system, 00:43:33.110 --> 00:43:36.219 you go do the dosing. It's a huge problem. You 00:43:36.219 --> 00:43:40.400 should never do that. Anyway, so now what we've 00:43:40.400 --> 00:43:42.360 done that have been like the biggest changes 00:43:42.360 --> 00:43:46.800 are we then said, okay, instead of an alphabetized 00:43:46.800 --> 00:43:49.860 list, what if we take your protocols, we ingest 00:43:49.860 --> 00:43:52.840 them into the app, and now if you only want to 00:43:52.840 --> 00:43:55.800 see your anaphylaxis protocol and only the drugs 00:43:55.800 --> 00:43:57.840 in Hentevi, we'll only show you those drugs. 00:43:58.969 --> 00:44:01.469 At a tap of a button, your protocol PDF comes 00:44:01.469 --> 00:44:04.130 up. At another tap of a button, a customized 00:44:04.130 --> 00:44:07.010 checklist comes up so that I could be running 00:44:07.010 --> 00:44:11.010 the anaphylaxis call. All the drugs, the dosing's 00:44:11.010 --> 00:44:13.170 right there. I'm tapping on it, and it's integrating 00:44:13.170 --> 00:44:16.610 into the EPCR. I could see my protocol in real 00:44:16.610 --> 00:44:18.190 time. I could see my checklist in real time. 00:44:18.409 --> 00:44:20.690 And then when I'm done with all that, I can just 00:44:20.690 --> 00:44:23.429 press send, and it all goes directly, cell by 00:44:23.429 --> 00:44:26.250 cell, into your electronic medical record. And 00:44:26.250 --> 00:44:29.079 we have 13. maybe think even 14 integrations 00:44:29.079 --> 00:44:33.219 with pretty much every EHR or EPCR vendor. That 00:44:33.219 --> 00:44:36.679 was a huge undertaking. And now we're with all 00:44:36.679 --> 00:44:40.539 of them. That was a big one. The other thing 00:44:40.539 --> 00:44:44.280 we did, my favorite feature is CPR assist, which 00:44:44.280 --> 00:44:48.960 is I learned that my agencies, all the CPR quality 00:44:48.960 --> 00:44:51.300 metrics were completely off. Compression rate, 00:44:51.340 --> 00:44:54.039 ventilation rate, the number of pauses and seconds 00:44:54.039 --> 00:44:56.719 of the pauses. So we created a metronome that, 00:44:57.039 --> 00:44:59.820 You just press start, and it talks to you. And 00:44:59.820 --> 00:45:02.340 you hear the boop, boop, boop. It tells you when 00:45:02.340 --> 00:45:03.639 to ventilate. It tells you when to charge the 00:45:03.639 --> 00:45:06.739 monitor. So we created like a super metronome 00:45:06.739 --> 00:45:11.159 that probably the most emails and texts I get 00:45:11.159 --> 00:45:14.239 today are because of the metronome. Okay, so 00:45:14.239 --> 00:45:17.340 then we added that feature in. Now we have quizzes. 00:45:17.480 --> 00:45:20.000 You can do an AI quiz and send it to your team. 00:45:20.260 --> 00:45:22.980 We have notification center. I'm building something 00:45:22.980 --> 00:45:25.380 called wall time alerts where a medic is on the 00:45:25.380 --> 00:45:29.889 wall. hour at some hospital, they can push a 00:45:29.889 --> 00:45:34.650 button and it just notifies all the right people 00:45:34.650 --> 00:45:36.670 at that hospital that, hey, I'm sitting on this 00:45:36.670 --> 00:45:40.170 wall. You better come help me. So now we've done 00:45:40.170 --> 00:45:43.329 all these things. And more and more, we have 00:45:43.329 --> 00:45:46.150 people who are telling us to add more features 00:45:46.150 --> 00:45:48.130 for documentation. And can't you just become 00:45:48.130 --> 00:45:50.750 an EHR? And the answer is no. We're going to 00:45:50.750 --> 00:45:53.449 stick to what we do, which is we're going to 00:45:53.449 --> 00:45:56.579 help you when someone's dying. to have the right 00:45:56.579 --> 00:46:00.079 information, to document that information, and 00:46:00.079 --> 00:46:02.679 to make sure that you can feel better going home 00:46:02.679 --> 00:46:05.780 that you gave this child or adult. Because now 00:46:05.780 --> 00:46:08.039 we do adults too. We're now adding a whole NICU 00:46:08.039 --> 00:46:14.320 section into it. And it's just been an incredible 00:46:14.320 --> 00:46:18.139 journey. Like I mentioned earlier, all 50 states, 00:46:18.260 --> 00:46:20.940 about 2 ,500 cities, four different countries, 00:46:21.280 --> 00:46:25.010 50 people here at Hantevi. who are incredible 00:46:25.010 --> 00:46:29.670 human beings and software engineers and customer 00:46:29.670 --> 00:46:32.070 service, customer success, logistics, clinical 00:46:32.070 --> 00:46:35.349 education. I mean, every department. And of course, 00:46:35.349 --> 00:46:38.989 my amazing wife, who is really like the engine 00:46:38.989 --> 00:46:41.469 behind all of this stuff. I'm just the idea guy. 00:46:42.389 --> 00:46:45.210 And I'm like the inspirational guy. Like, hey, 00:46:45.269 --> 00:46:47.449 this is why this is important. But she's actually 00:46:47.449 --> 00:46:50.500 doing it. and leading a team of incredible people. 00:46:50.599 --> 00:46:53.980 The best part of the journey has been the people 00:46:53.980 --> 00:46:59.780 for me. When I think about taking a moment and 00:46:59.780 --> 00:47:02.920 checking an Antevi app or simply checking protocols, 00:47:03.539 --> 00:47:06.760 I'm always reminded of a real -life story from 00:47:06.760 --> 00:47:08.900 my career actually included in Kinder in the 00:47:08.900 --> 00:47:12.619 book. I was in Anaheim, and we had basically 00:47:12.619 --> 00:47:16.559 a gangbanger that was dropped off in a community 00:47:16.559 --> 00:47:20.039 hospital, basically. And we were called to transport 00:47:20.039 --> 00:47:22.079 them. And right when we're about to put them 00:47:22.079 --> 00:47:23.719 on the stretcher, I've got the monitor and he 00:47:23.719 --> 00:47:27.980 goes from normal sinus to Brady to asystole. 00:47:28.519 --> 00:47:32.960 And the doctor at the time, they called the trauma 00:47:32.960 --> 00:47:35.139 center and that doctor was actually coming to 00:47:35.139 --> 00:47:38.699 this hospital. He brought his gear and he headed 00:47:38.699 --> 00:47:41.340 that way. In the meantime, the doctor did cardiac 00:47:41.340 --> 00:47:43.840 massage. But I'll never forget, he opened a textbook. 00:47:44.440 --> 00:47:47.179 And he verified what he needed to do because 00:47:47.179 --> 00:47:49.420 he hadn't obviously done cardiac massage in a 00:47:49.420 --> 00:47:51.860 long, long time. He was probably in his 40s, 00:47:51.860 --> 00:47:53.500 if I'm recalling right. So he'd probably been 00:47:53.500 --> 00:47:55.219 out of med school for quite a while. But I remember 00:47:55.219 --> 00:47:59.000 being struck by the humility of saying, let me 00:47:59.000 --> 00:48:02.519 check. And what I see in what I would argue the 00:48:02.519 --> 00:48:05.039 bad paramedics that I've worked with is an arrogance 00:48:05.039 --> 00:48:08.730 that creates a lot of danger. Rather than having 00:48:08.730 --> 00:48:10.909 the humility to ask someone else, hey, have I 00:48:10.909 --> 00:48:13.210 got this right? Or to check an app or to check 00:48:13.210 --> 00:48:16.349 a book. So talk to me about that in your experience, 00:48:16.530 --> 00:48:20.329 humility in our profession specifically. I think 00:48:20.329 --> 00:48:22.670 that's the perfect word for it. And yesterday 00:48:22.670 --> 00:48:25.590 I was talking to our new hires at Palm Beach 00:48:25.590 --> 00:48:29.610 Gardens. And I didn't use the word humility. 00:48:29.750 --> 00:48:31.230 I think that's probably a better word to use. 00:48:31.550 --> 00:48:35.309 But the thrust of what I was saying. Yesterday 00:48:35.309 --> 00:48:37.750 was exactly what you said. I said, there's one 00:48:37.750 --> 00:48:41.110 thing that you should take away from today is 00:48:41.110 --> 00:48:43.289 that you're dealing with people. You're dealing 00:48:43.289 --> 00:48:45.710 with people at their worst times, and you're 00:48:45.710 --> 00:48:51.090 not going to know everything. And I said, you 00:48:51.090 --> 00:48:53.869 know, the reason you have great leaders here, 00:48:53.989 --> 00:48:55.849 the reason that you have a medical director who's 00:48:55.849 --> 00:49:01.250 on call for you 24 by 7 by 365. It is so that 00:49:01.250 --> 00:49:03.469 you can utilize those resources and not just 00:49:03.469 --> 00:49:05.630 be out there on an island by yourself because 00:49:05.630 --> 00:49:08.489 you don't know something. And what I've realized 00:49:08.489 --> 00:49:12.070 that this is very – this whole psychology is 00:49:12.070 --> 00:49:13.730 very interesting. I don't think many people understand 00:49:13.730 --> 00:49:17.250 this part of it unless you're in EMS, which is 00:49:17.250 --> 00:49:22.329 that paramedics won't even call the medical director 00:49:22.329 --> 00:49:25.369 because they're scared. Now, what are they scared 00:49:25.369 --> 00:49:30.170 of? they're scared of being yelled at. They're 00:49:30.170 --> 00:49:32.989 scared of being pushed down. They're scared of 00:49:32.989 --> 00:49:34.670 being called stupid. They're scared of being 00:49:34.670 --> 00:49:37.789 remediated. So in all of my agencies, it took 00:49:37.789 --> 00:49:42.070 me years to gain the trust, just to gain the 00:49:42.070 --> 00:49:45.250 trust of all the folks that I work with to say, 00:49:45.369 --> 00:49:48.130 when we call Peter Rantevi, it's going to be 00:49:48.130 --> 00:49:51.230 nice. He's not going to, you know, he's not going 00:49:51.230 --> 00:49:53.670 to minimize what we do. He's not going to say, 00:49:53.710 --> 00:49:56.269 why did you call, right? Never going to do that. 00:49:56.889 --> 00:49:58.769 He's never ever going to say, you should have 00:49:58.769 --> 00:50:01.510 done this before calling me. It's always going 00:50:01.510 --> 00:50:03.909 to be, I am so happy you called me. Thank you 00:50:03.909 --> 00:50:08.090 so much. And after years of doing that, now I 00:50:08.090 --> 00:50:14.530 get, my phone gets flooded every day. And I'm 00:50:14.530 --> 00:50:16.710 trying to develop that culture of humility. I'm 00:50:16.710 --> 00:50:18.630 trying to develop the culture where someone says, 00:50:18.829 --> 00:50:22.170 I don't know what I'm doing. And I'm going to 00:50:22.170 --> 00:50:25.210 actually phone a friend, right? And so, of course, 00:50:25.269 --> 00:50:28.570 we've written the protocols for this, but there 00:50:28.570 --> 00:50:30.690 shouldn't have to be a protocol when you know 00:50:30.690 --> 00:50:34.489 that you can call somebody to actually do that. 00:50:34.550 --> 00:50:36.710 And we probably won't get into it today, but 00:50:36.710 --> 00:50:39.989 I've created, and I'm really thinking hard about 00:50:39.989 --> 00:50:43.150 AI and where AI would come in, but I've created 00:50:43.150 --> 00:50:47.070 an AI bot of myself. And I've uploaded every 00:50:47.070 --> 00:50:50.139 podcast, every blog. every paper I've written 00:50:50.139 --> 00:50:52.699 and all the papers that I believe in. And then 00:50:52.699 --> 00:50:55.840 this program allows me to kind of say, you know, 00:50:55.840 --> 00:50:58.219 take this paper and give it a score of 10 out 00:50:58.219 --> 00:51:00.619 of 10 because I want you to really rely on this 00:51:00.619 --> 00:51:04.539 particular thing heavily. So now if I send you 00:51:04.539 --> 00:51:07.219 the link, James, you can click on talk to Peter 00:51:07.219 --> 00:51:10.019 Renteve and we can have an entire conversation 00:51:10.019 --> 00:51:14.219 about anything and it's going to be me talking 00:51:14.219 --> 00:51:17.900 to you. And so I floated it out to about, you 00:51:17.900 --> 00:51:20.719 know, maybe about 100 people have the link so 00:51:20.719 --> 00:51:26.659 far. But there's going to come a day where people 00:51:26.659 --> 00:51:30.800 will be able to speak to their medical director, 00:51:30.920 --> 00:51:33.559 even though it's less personal, I get it. But 00:51:33.559 --> 00:51:36.639 I work with over 3 ,000 paramedics now, Brevard 00:51:36.639 --> 00:51:38.300 County, Indian River County, Palm Beach County, 00:51:38.480 --> 00:51:40.480 Broward County, and then the private ambulance 00:51:40.480 --> 00:51:42.500 company, which goes through probably 10 more 00:51:42.500 --> 00:51:46.699 counties. I want people to be able to have that 00:51:46.699 --> 00:51:51.440 access. And so I do think there's a future using 00:51:51.440 --> 00:51:55.820 voice AI that's here today already that I think 00:51:55.820 --> 00:51:59.780 will create a lot of value and be able to lower 00:51:59.780 --> 00:52:03.699 the bar for that humility to occur because people 00:52:03.699 --> 00:52:06.599 will tell a bot much more than they'll tell. 00:52:06.719 --> 00:52:10.820 So if there was a James Gearing bot and you put 00:52:10.820 --> 00:52:12.969 it out there and you say, Here's a James Gearing 00:52:12.969 --> 00:52:15.210 bot that you could talk to me about anything 00:52:15.210 --> 00:52:18.070 that's on your mind. People will use that bot 00:52:18.070 --> 00:52:20.289 and tell the bot things it would never, ever 00:52:20.289 --> 00:52:24.309 tell you. And so there's power in that that I 00:52:24.309 --> 00:52:26.110 think we need to leverage in the coming years. 00:52:27.329 --> 00:52:29.590 Speaking of technology, just to go off on a totally 00:52:29.590 --> 00:52:35.250 different tangent, when we look at the, I used 00:52:35.250 --> 00:52:37.929 to call it 911 abuse, but I love the way that 00:52:37.929 --> 00:52:42.340 GMR calls it, the three -tier system. I had a 00:52:42.340 --> 00:52:44.900 couple of guys from GMR, their medical director 00:52:44.900 --> 00:52:46.679 and one of the paramedics that works for them 00:52:46.679 --> 00:52:52.500 now. The creation of, you've got ALS, you've 00:52:52.500 --> 00:52:55.099 got BLS, and then you've got arguably non -emergent. 00:52:55.550 --> 00:52:58.349 And bringing in what they have in GMR is called 00:52:58.349 --> 00:53:01.489 nurse navigation. So a third party that is embedded 00:53:01.489 --> 00:53:06.750 in 911. So initially the EMD dispatch algorithm 00:53:06.750 --> 00:53:09.550 is figuring out, okay, is this a Charlie? Is 00:53:09.550 --> 00:53:11.769 this an Echo? And then it goes down to, okay, 00:53:11.849 --> 00:53:15.659 this is a low acuity call. And the caller is 00:53:15.659 --> 00:53:18.579 given the opportunity to speak to a nurse. And 00:53:18.579 --> 00:53:20.340 I think the perfect example is, you know, the 00:53:20.340 --> 00:53:22.659 new couple, they've got an 18 -month -old. It's 00:53:22.659 --> 00:53:24.119 the first time it's had a fever. It's thrown 00:53:24.119 --> 00:53:26.619 up once. Oh, my toddler's going to explode and 00:53:26.619 --> 00:53:29.320 die of, you know, dehydration. We've all been 00:53:29.320 --> 00:53:31.679 on those calls. And they're like, oh, yeah, actually, 00:53:31.760 --> 00:53:34.159 I'd love to talk to that. They have the ability 00:53:34.159 --> 00:53:37.099 to treat at home. So literally say, you know, 00:53:37.099 --> 00:53:38.760 okay, strip the clothes off. Do you have kids' 00:53:38.840 --> 00:53:41.960 Tylenol? Okay, this is the dose. or schedule 00:53:41.960 --> 00:53:44.000 an urgent care clinic for the following morning, 00:53:44.179 --> 00:53:46.900 you know, opticianry, dentistry, you know, mental 00:53:46.900 --> 00:53:50.210 health, anything that's low acuity. I love that 00:53:50.210 --> 00:53:54.170 idea to remove some of the calls that truly are 00:53:54.170 --> 00:53:57.010 not emergencies. And I think it's a three -way 00:53:57.010 --> 00:54:00.070 win. The paramedics or firefighters don't get 00:54:00.070 --> 00:54:02.909 woken up for that call. An ER bed stays available 00:54:02.909 --> 00:54:06.769 for a more urgent call. And the family get a 00:54:06.769 --> 00:54:09.349 bill for a few hundred dollars instead of a few 00:54:09.349 --> 00:54:12.269 thousand dollars. What is your take on that integration 00:54:12.269 --> 00:54:16.090 of telehealth to reduce the workload on our EMTs 00:54:16.090 --> 00:54:18.920 and paramedics? Yeah, so that was a beautiful 00:54:18.920 --> 00:54:21.059 description. I've been involved in this space 00:54:21.059 --> 00:54:24.679 for a long time. And so when the GMR folks were 00:54:24.679 --> 00:54:27.820 doing this stuff, I was on the phone with them. 00:54:28.280 --> 00:54:32.320 I've been following along. And I created a version 00:54:32.320 --> 00:54:38.619 of this back in 2015 for specifically the elderly 00:54:38.619 --> 00:54:41.500 population, Medicare population, 65 and over. 00:54:43.519 --> 00:54:46.460 And I actually was invited up to speak to CMS 00:54:46.460 --> 00:54:50.019 many, many years ago about this type of care, 00:54:50.199 --> 00:54:53.659 right? So what do I think about it? I think it's 00:54:53.659 --> 00:54:56.420 the future, number one. But here's the caveat. 00:54:56.539 --> 00:54:59.760 Here's the but. That there's going to be a day 00:54:59.760 --> 00:55:03.940 now with AI and mobile technologies, mobile labs, 00:55:04.039 --> 00:55:08.860 et cetera, where you, the user, the, you know, 00:55:09.159 --> 00:55:11.679 regular lay person will be able to have your 00:55:11.679 --> 00:55:14.300 AI health agent. And you're going to tell the 00:55:14.300 --> 00:55:15.960 agent, the agent's going to have all of your 00:55:15.960 --> 00:55:17.880 medical records. You'll know everything about 00:55:17.880 --> 00:55:19.739 you. And you're going to open it up and you're 00:55:19.739 --> 00:55:22.900 going to say, all right, agent, what's going 00:55:22.900 --> 00:55:25.280 on this month for me? All right. Well, Pete, 00:55:25.480 --> 00:55:27.980 it looks like you need your colonoscopy done. 00:55:28.159 --> 00:55:30.000 Let me get that scheduled for you. Okay. Thank 00:55:30.000 --> 00:55:32.940 you. We're going to need blood work done. Let 00:55:32.940 --> 00:55:34.780 me get someone to come to your house and we'll 00:55:34.780 --> 00:55:37.369 schedule that. And then once the blood work is 00:55:37.369 --> 00:55:41.849 in, I'll give you – so that's coming. In the 00:55:41.849 --> 00:55:45.949 meantime, I'm going to go back to what you mentioned 00:55:45.949 --> 00:55:49.889 earlier, which is someone calls 911. So obviously 00:55:49.889 --> 00:55:51.750 what I just described to you are going to be 00:55:51.750 --> 00:55:53.929 people who have the money, have the know -how, 00:55:53.929 --> 00:55:55.769 have the resource. Those are going to be the 00:55:55.769 --> 00:55:57.869 early adopters. Then you still have the people 00:55:57.869 --> 00:56:02.730 calling 911. So there are several companies doing 00:56:02.730 --> 00:56:06.199 this. One is called Tele911. One is called MD 00:56:06.199 --> 00:56:09.420 Ally. And what they realized, both of those companies 00:56:09.420 --> 00:56:11.739 came out of the gate trying to sell to the fire 00:56:11.739 --> 00:56:14.579 department this. They said, your medic's going 00:56:14.579 --> 00:56:16.659 to get there. He's going to have a patient. The 00:56:16.659 --> 00:56:18.119 18 -month -old doesn't need to go to the ER. 00:56:18.840 --> 00:56:21.679 And at the moment that you're in front of the 00:56:21.679 --> 00:56:24.000 patient, you're going to say, let me get you, 00:56:24.039 --> 00:56:27.340 Dr. Antebi, on the line. Click. Now I engage 00:56:27.340 --> 00:56:30.539 with the patient, and the patient doesn't need 00:56:30.539 --> 00:56:33.889 to get transported. The problem with this is 00:56:33.889 --> 00:56:38.170 if you're the fire chief and the EMS system is 00:56:38.170 --> 00:56:39.530 screwed up today because we only get paid for 00:56:39.530 --> 00:56:42.230 transports. I came to the fire chief and I said, 00:56:42.289 --> 00:56:43.750 chief, I have the greatest idea. He said, oh, 00:56:43.750 --> 00:56:46.449 Pete, what is it? I said, I'm going to reduce 00:56:46.449 --> 00:56:49.230 the number of transports. He said, say that one 00:56:49.230 --> 00:56:51.130 more time. I said, I'm going to reduce the number 00:56:51.130 --> 00:56:53.329 of transports. He says, okay, see that door? 00:56:53.449 --> 00:56:56.250 You can walk out of the office. Then I quickly 00:56:56.250 --> 00:56:59.849 realized that, okay, there has to be a payment 00:56:59.849 --> 00:57:02.539 model. That'll make the fire chief say, wait 00:57:02.539 --> 00:57:04.460 a minute, we don't have to go to that patient 00:57:04.460 --> 00:57:08.659 and we're still going to get paid. So in a perfect 00:57:08.659 --> 00:57:11.239 world, this is what, so I think the AMR, GMR 00:57:11.239 --> 00:57:12.639 people have done it very well because they're 00:57:12.639 --> 00:57:15.099 getting paid. If you go to a fire department 00:57:15.099 --> 00:57:17.820 today and you say, chief, we have this thing 00:57:17.820 --> 00:57:19.840 where they're going to call dispatch. We're going 00:57:19.840 --> 00:57:23.039 to transfer them to a third party, MDLI, tele 00:57:23.039 --> 00:57:26.500 911, which are great people. Those people are 00:57:26.500 --> 00:57:29.199 going to bill the patient. The fire department 00:57:29.199 --> 00:57:32.960 lost that revenue. So there is this push and 00:57:32.960 --> 00:57:38.139 pull between what's coming and what the department 00:57:38.139 --> 00:57:41.099 needs financially. So what I think is going to 00:57:41.099 --> 00:57:43.619 happen is, unfortunately, because the fire department 00:57:43.619 --> 00:57:46.119 needs to wake up and say, this is like we're 00:57:46.119 --> 00:57:48.380 in a Kodak moment right now. I think you know 00:57:48.380 --> 00:57:50.719 what I mean. We're in a yellow cab moment where 00:57:50.719 --> 00:57:57.280 there are people now, ambulance, doc go, ready 00:57:57.280 --> 00:58:00.269 responder. that are in our neighborhoods currently 00:58:00.269 --> 00:58:04.369 that are marketing to individuals like that family 00:58:04.369 --> 00:58:06.269 with the 18 -month -old. They're going to have 00:58:06.269 --> 00:58:09.070 an app, and they're going to say, I want someone 00:58:09.070 --> 00:58:12.610 to come to my house right now. Click. Okay, we'll 00:58:12.610 --> 00:58:14.469 be there in 15 minutes. And they're going to 00:58:14.469 --> 00:58:16.769 have blood work, and then they're going to have 00:58:16.769 --> 00:58:18.849 the ability to talk to the doctor, and they're 00:58:18.849 --> 00:58:20.269 going to bill those people. Don't get me wrong. 00:58:20.909 --> 00:58:23.110 But the insurance company is going to say, what's 00:58:23.110 --> 00:58:26.059 that visit cost me, $450? The ER would have cost 00:58:26.059 --> 00:58:28.079 me two grand and the admission would have cost 00:58:28.079 --> 00:58:30.599 me another eight grand. I'll pay that 450 all 00:58:30.599 --> 00:58:33.400 day long. Those companies already exist today. 00:58:34.559 --> 00:58:36.739 Why does the fire department not want to engage? 00:58:37.099 --> 00:58:42.780 What I learned is the fire department is given 00:58:42.780 --> 00:58:44.880 a budget. Let's say I'm making up a number, $10 00:58:44.880 --> 00:58:48.360 million. You have to run the department and not 00:58:48.360 --> 00:58:51.159 go over budget. That's your goal. The fire department 00:58:51.159 --> 00:58:53.630 is not looking to make a profit. by going and 00:58:53.630 --> 00:58:56.050 engaging with a third party and, okay, we're 00:58:56.050 --> 00:58:57.489 going to collect this amount of money and we're 00:58:57.489 --> 00:58:58.989 going to, no, they don't do any of that stuff. 00:58:59.710 --> 00:59:02.789 So one of the talks that I give now, one of the 00:59:02.789 --> 00:59:05.110 keynotes I give is called The Future of EMS, 00:59:05.329 --> 00:59:09.969 where I implore people to wake up because the 00:59:09.969 --> 00:59:12.010 fire department should be doing what you're talking 00:59:12.010 --> 00:59:14.030 about. The fire department should be getting 00:59:14.030 --> 00:59:16.889 a nurse navigator or someone else navigating 00:59:16.889 --> 00:59:21.550 the care. But we are letting other people come 00:59:21.550 --> 00:59:26.130 in and do what we should be doing. And unfortunately, 00:59:26.449 --> 00:59:29.570 I hate to say it, there's going to come a day 00:59:29.570 --> 00:59:33.590 where all of the good paying customers are going 00:59:33.590 --> 00:59:36.289 to be taken away. And the only calls we're going 00:59:36.289 --> 00:59:38.630 to get, James, are the folks who have no resources. 00:59:39.110 --> 00:59:41.570 They're in the poorest communities. They have 00:59:41.570 --> 00:59:45.849 the worst access to care. All the social determinants 00:59:45.849 --> 00:59:49.510 are at the lowest levels. And EMS is going to 00:59:49.510 --> 00:59:53.539 be relegated to that aspect. Instead of us being 00:59:53.539 --> 00:59:57.119 able to add another appendage and say, we're 00:59:57.119 --> 00:59:59.179 going to do that. And we're going to come to 00:59:59.179 --> 01:00:02.019 your house with blood work. We should be doing 01:00:02.019 --> 01:00:06.119 that. But EMS is so upside down with payment 01:00:06.119 --> 01:00:10.260 that they can't get out of their own way. I mean, 01:00:10.260 --> 01:00:12.480 not purposely, but the federal government can't 01:00:12.480 --> 01:00:15.780 figure out that we're not a hearse anymore. We 01:00:15.780 --> 01:00:17.699 should not be just getting paid for transport 01:00:17.699 --> 01:00:21.420 like they did in 1965. We need to be getting 01:00:21.420 --> 01:00:26.539 paid for navigating the patient to the best and 01:00:26.539 --> 01:00:30.239 most appropriate care, whether it be an urgent 01:00:30.239 --> 01:00:33.420 care or via an Uber ride after the 911 call to 01:00:33.420 --> 01:00:37.159 dispatch, rather than send out the engine, send 01:00:37.159 --> 01:00:41.000 out the ambulance with seven people only to find 01:00:41.000 --> 01:00:42.960 out that the patient is going to refuse care 01:00:42.960 --> 01:00:45.380 after you've done all the vital signs, the 12 01:00:45.380 --> 01:00:48.960 lead, given them Zofran, and then they say, you 01:00:48.960 --> 01:00:51.789 know what, guys? you were great but i don't need 01:00:51.789 --> 01:00:54.030 you anymore that's what's happening today it's 01:00:54.030 --> 01:00:57.210 it's so backwards that it's hard for even to 01:00:57.210 --> 01:01:01.530 fathom that that we have a system like that that 01:01:01.530 --> 01:01:04.070 does so much good for society that can't get 01:01:04.070 --> 01:01:06.789 out of its own way that's what i think well i'm 01:01:06.789 --> 01:01:08.610 so glad i asked that because this is a you know 01:01:08.610 --> 01:01:10.309 yet another different perspective because this 01:01:10.309 --> 01:01:12.289 is a new conversation so i've only got a few 01:01:12.289 --> 01:01:16.170 kind of you know perspectives so far going on 01:01:16.170 --> 01:01:18.889 the complete other side I wanted to touch on 01:01:18.889 --> 01:01:21.409 COVID because you and I spoke in 2019 last time, 01:01:21.429 --> 01:01:24.849 as far as this kind of interview, where I think 01:01:24.849 --> 01:01:27.750 there was such a huge disservice was not whether 01:01:27.750 --> 01:01:29.789 you believe the virus is real or not, whether 01:01:29.789 --> 01:01:32.550 you thought the vaccine was the be all and end 01:01:32.550 --> 01:01:34.550 all or was going to make your head explode, wherever 01:01:34.550 --> 01:01:37.250 you were on the scale. The middle common sense 01:01:37.250 --> 01:01:40.590 ground was if we make our nation healthier, whatever 01:01:40.590 --> 01:01:43.010 comes next is going to have less of an impact. 01:01:43.320 --> 01:01:47.000 No one can argue that fact. And even remove the 01:01:47.000 --> 01:01:50.400 virus. If you make people healthier, a few million 01:01:50.400 --> 01:01:55.019 people won't die that were if we didn't. So with 01:01:55.019 --> 01:01:58.099 this perspective, going all the way back, what 01:01:58.099 --> 01:02:02.260 was the education in your medical journey as 01:02:02.260 --> 01:02:06.889 far as sleep, nutrition, exercise? And then let's 01:02:06.889 --> 01:02:09.730 go the other side of COVID. What should we be 01:02:09.730 --> 01:02:12.530 talking about now so that we don't have so many 01:02:12.530 --> 01:02:14.869 EMS calls in the first place because we're forging 01:02:14.869 --> 01:02:18.250 a healthier population? That's what a great question. 01:02:18.309 --> 01:02:20.889 I just had lunch with a good friend of mine, 01:02:21.050 --> 01:02:24.750 Jesse Carroll, and we were just talking about 01:02:24.750 --> 01:02:30.030 exactly this. And because, you know, I'm at the 01:02:30.030 --> 01:02:33.739 age now where. I recognize that the health care 01:02:33.739 --> 01:02:35.780 should not be called health care in this country. 01:02:35.840 --> 01:02:38.780 It should be called sick care. They only want 01:02:38.780 --> 01:02:40.840 to see you when you're sick because they can 01:02:40.840 --> 01:02:43.239 only make money off you when you're sick. And 01:02:43.239 --> 01:02:44.860 then they can prescribe you and send you to the 01:02:44.860 --> 01:02:46.940 cardiologist and another echo and another this 01:02:46.940 --> 01:02:49.239 and another that. And they're ringing up the 01:02:49.239 --> 01:02:51.880 bill. Cha -ching, cha -ching, cha -ching. But 01:02:51.880 --> 01:02:54.159 if they're going to make you healthy, it requires 01:02:54.159 --> 01:02:58.480 more time, more sit down, more explanation. And 01:02:58.480 --> 01:03:01.760 then no one's paying for preventative care. Even 01:03:01.760 --> 01:03:04.480 this concept of value -based care in America 01:03:04.480 --> 01:03:07.480 never really took off for the reasons I just 01:03:07.480 --> 01:03:11.000 described. So when you look at COVID and the 01:03:11.000 --> 01:03:14.699 people who got the brunt of it, it was the seniors, 01:03:14.920 --> 01:03:17.380 it was the diabetics, it was the hypertensive, 01:03:17.480 --> 01:03:20.239 it was the obese patients. So to your point, 01:03:20.599 --> 01:03:26.280 if we had a healthier population perhaps, then 01:03:26.280 --> 01:03:29.840 we would have saved a lot of lives. But that's 01:03:29.840 --> 01:03:36.610 kind of... that's a tough argument to make people 01:03:36.610 --> 01:03:40.329 change from what they currently do today when 01:03:40.329 --> 01:03:43.349 everywhere you turn in this country is a fast 01:03:43.349 --> 01:03:45.989 food, is a chips, is a soda, is Mountain Dew. 01:03:47.230 --> 01:03:51.690 And we've come to a point in our society where, 01:03:51.750 --> 01:03:56.570 you know, I'm not saying there's a point of no 01:03:56.570 --> 01:03:58.809 return, but you now see that the pendulum is 01:03:58.809 --> 01:04:01.469 swinging the other way where, Even I am having 01:04:01.469 --> 01:04:03.449 conversations with a friend just now literally 01:04:03.449 --> 01:04:09.289 about testing my VO2 max and, you know, thinking 01:04:09.289 --> 01:04:13.710 about peptides and, you know, reducing inflammation 01:04:13.710 --> 01:04:17.409 in my body and even learning how to breathe differently. 01:04:18.469 --> 01:04:22.409 Very fascinating. He told me at lunchtime, he 01:04:22.409 --> 01:04:25.869 says, this guy tests people. He does this on 01:04:25.869 --> 01:04:30.659 the side as a living. He says that. Your typical 01:04:30.659 --> 01:04:33.159 minute ventilation should be, let's say, four 01:04:33.159 --> 01:04:34.920 to seven liters per minute. So when you're sitting 01:04:34.920 --> 01:04:37.460 there on the couch watching Netflix, if I would 01:04:37.460 --> 01:04:40.219 measure the volume of air you're breathing in 01:04:40.219 --> 01:04:42.579 and out per minute, it's, let's say, four to 01:04:42.579 --> 01:04:45.639 seven liters. He says the average person today 01:04:45.639 --> 01:04:50.199 is breathing 11 liters per minute. He says that 01:04:50.199 --> 01:04:55.320 in and of itself is reducing your life expectancy. 01:04:55.820 --> 01:04:57.659 Now, I'm not going to go through the physiology, 01:04:57.880 --> 01:05:01.289 but this guy's a super... super smart guy and 01:05:01.289 --> 01:05:04.329 he measured his vo2 max and if you're in a low 01:05:04.329 --> 01:05:08.429 end of vo2 max then you have like a significantly 01:05:08.429 --> 01:05:10.869 higher chance of dying from stroke and cardiac 01:05:10.869 --> 01:05:14.070 and all the all you know the big the big diseases 01:05:14.070 --> 01:05:17.030 you know diabetes etc and he says if you if you 01:05:17.030 --> 01:05:19.489 change your vo2 max by breathing differently 01:05:19.489 --> 01:05:23.590 simply breathing differently um then you can 01:05:23.590 --> 01:05:26.369 have a healthier america right no one's talking 01:05:26.369 --> 01:05:29.820 about that i said jesse where did you get this 01:05:29.820 --> 01:05:33.579 from? And he says, well, you know, I know people, 01:05:33.619 --> 01:05:36.460 I go to conferences and so forth, but that information 01:05:36.460 --> 01:05:38.760 is nowhere to be found unless you happen to know 01:05:38.760 --> 01:05:40.659 somebody. And I said, where's your research, 01:05:40.659 --> 01:05:42.000 right? I'm evidence -based. Where's the research 01:05:42.000 --> 01:05:46.760 on that? And so, unfortunately, going through 01:05:46.760 --> 01:05:50.539 and following Jesse's protocol and he kind of 01:05:50.539 --> 01:05:53.139 gives you the bag and he teaches your brain how 01:05:53.139 --> 01:05:56.019 to breathe again and he tests your VO2 max and 01:05:56.019 --> 01:05:58.909 all that kind of stuff. Like, The only way people 01:05:58.909 --> 01:06:01.190 are going to do that is if they actually care 01:06:01.190 --> 01:06:04.510 about longevity. But that's becoming a very important 01:06:04.510 --> 01:06:08.349 topic in today's society. But again, it's not 01:06:08.349 --> 01:06:11.849 everybody talking about that. But just to kind 01:06:11.849 --> 01:06:14.030 of circle back around to your question, is that 01:06:14.030 --> 01:06:17.449 if we began to focus instead of sick care, but 01:06:17.449 --> 01:06:21.269 really health care in America, then we would 01:06:21.269 --> 01:06:25.900 potentially minimize the... tragedy of the next 01:06:25.900 --> 01:06:28.039 virus, which there's going to be one, right? 01:06:28.099 --> 01:06:32.780 We all know that we happen to experience a virus 01:06:32.780 --> 01:06:35.860 that had a specific death rate affiliated with 01:06:35.860 --> 01:06:38.280 it. But what happens when the next virus comes 01:06:38.280 --> 01:06:41.780 out that has a higher mortality, a higher morbidity? 01:06:43.199 --> 01:06:46.420 You start to worry about not losing just a million 01:06:46.420 --> 01:06:50.800 people, but millions of people. And a healthier 01:06:50.800 --> 01:06:52.800 America would definitely fix that problem. There's 01:06:52.800 --> 01:06:55.050 no doubt about it. I think this is just such 01:06:55.050 --> 01:06:58.429 an important conversation. And I think the problem 01:06:58.429 --> 01:07:02.289 with the people that have fallen below where 01:07:02.289 --> 01:07:05.070 they need to be physically is now there's guilt 01:07:05.070 --> 01:07:09.010 and shame applied to them, whether it's fat shaming 01:07:09.010 --> 01:07:11.050 or whatever it is. And the thing is that term 01:07:11.050 --> 01:07:13.789 now is used to block people from actually making 01:07:13.789 --> 01:07:16.010 progress and getting back to where they want 01:07:16.010 --> 01:07:18.369 to be. Because during COVID, for example, talking 01:07:18.369 --> 01:07:21.079 about obesity. That was the whole, you know, 01:07:21.099 --> 01:07:23.659 2020 Black Lives Matter. Everyone was so hyper 01:07:23.659 --> 01:07:26.099 -triggered about everything that you couldn't 01:07:26.099 --> 01:07:27.820 address the very things that were important. 01:07:28.300 --> 01:07:31.820 But understanding that, as Winston Churchill 01:07:31.820 --> 01:07:33.940 said, and I'm paraphrasing, but you can measure 01:07:33.940 --> 01:07:36.460 the greatness of a nation by the health of their 01:07:36.460 --> 01:07:39.920 people. And we are 70 % obese or overweight. 01:07:41.099 --> 01:07:43.460 Therein lies a problem. But understanding that 01:07:43.460 --> 01:07:45.559 these people are a product of their environment. 01:07:46.039 --> 01:07:47.900 And I've made this very clear many, many times. 01:07:48.000 --> 01:07:50.860 I grew up on a farm in England. We had an orchard. 01:07:50.860 --> 01:07:53.320 We had a vegetable garden. We slaughtered our 01:07:53.320 --> 01:07:56.659 own meat. So, of course, I'm going to know about 01:07:56.659 --> 01:07:58.760 where meat comes from and how to move and how 01:07:58.760 --> 01:08:00.539 to eat because it was ingrained in my upbringing. 01:08:00.920 --> 01:08:04.019 If I grew up in Brooklyn and the bodega was the 01:08:04.019 --> 01:08:05.900 only thing I knew about where food came from, 01:08:06.059 --> 01:08:08.059 very different conversation. So I'm not going 01:08:08.059 --> 01:08:10.420 to look down my nose at someone who's not in 01:08:10.420 --> 01:08:12.059 great shape and be like, why don't you just be 01:08:12.059 --> 01:08:15.519 like me? What a narcissistic thing to say. So 01:08:15.519 --> 01:08:17.199 you have to take a step back and look at the 01:08:17.199 --> 01:08:19.979 environment. But going back to this COVID thing, 01:08:20.140 --> 01:08:22.659 how many people screamed, oh, but it's about 01:08:22.659 --> 01:08:25.439 the health of the people. And it was never about 01:08:25.439 --> 01:08:27.340 the health of the people. As you pointed out, 01:08:27.859 --> 01:08:31.060 you know, we have, you know, we demonize illicit 01:08:31.060 --> 01:08:35.039 drugs, but we have a drug dealer, you know, who's 01:08:35.039 --> 01:08:37.220 literally lining the pockets of the left and 01:08:37.220 --> 01:08:40.779 the right, keeping the sick care going because. 01:08:41.340 --> 01:08:43.119 There's no money in healthy people, and there's 01:08:43.119 --> 01:08:44.619 also no money in dead people, so you've got to 01:08:44.619 --> 01:08:46.640 keep them alive. But you've got the ultimate 01:08:46.640 --> 01:08:50.239 addict in your hypertensive, your hyperglycemic, 01:08:50.239 --> 01:08:53.260 and all these other chronic diseases. Listen, 01:08:53.399 --> 01:08:56.399 I have a son who's type 1 diabetic, and listen, 01:08:57.380 --> 01:08:59.420 I'm not a conspiracy theorist by nature, but 01:08:59.420 --> 01:09:02.260 I will tell you that we spend so much money on 01:09:02.260 --> 01:09:04.640 diabetes every month for my son just to keep 01:09:04.640 --> 01:09:06.100 him alive, right, because without the insulin, 01:09:06.119 --> 01:09:10.659 he'd be dead. And I know that a cure... would 01:09:10.659 --> 01:09:16.279 not be beneficial to this big, massive industrial 01:09:16.279 --> 01:09:20.899 complex called pharmaceutical care, right? And 01:09:20.899 --> 01:09:28.000 so I always wonder if any of these diseases will 01:09:28.000 --> 01:09:30.239 be cured because it's not worth it for them to 01:09:30.239 --> 01:09:33.560 be cured. And there's so many stories. I do a 01:09:33.560 --> 01:09:36.100 lot of reading now about a lot of different things 01:09:36.100 --> 01:09:40.119 outside of medicine to understand. why certain 01:09:40.119 --> 01:09:42.840 things in medicine are being blocked or don't 01:09:42.840 --> 01:09:45.579 happen. And it turns out it's all through society, 01:09:45.819 --> 01:09:48.560 right? When you look at just a simple example 01:09:48.560 --> 01:09:52.399 that I heard recently is Expedia, the Expedia 01:09:52.399 --> 01:09:54.680 website where you can go on and make your own 01:09:54.680 --> 01:09:57.640 flight. The guy who developed that, I listened 01:09:57.640 --> 01:10:00.000 to a podcast from him recently, he said that 01:10:00.000 --> 01:10:02.659 they brought so many lawyers against this guy, 01:10:02.760 --> 01:10:05.779 but he had the backing of Microsoft at the time. 01:10:06.610 --> 01:10:08.949 He's the same guy who created Zillow, the real 01:10:08.949 --> 01:10:11.449 estate website. When he tried to create Zillow, 01:10:11.609 --> 01:10:14.250 they tried to shut him down every which way. 01:10:14.409 --> 01:10:18.449 Every which way. Why? Because the real estate 01:10:18.449 --> 01:10:21.930 industry had monopolized this data. They kept 01:10:21.930 --> 01:10:25.010 it to their own selves. And he said, no, we're 01:10:25.010 --> 01:10:29.029 going to. So now let's go to hospital care. There 01:10:29.029 --> 01:10:36.050 was vitals .com tried to make public. outcomes 01:10:36.050 --> 01:10:39.909 of hospitals for certain disease states, a stroke 01:10:39.909 --> 01:10:42.670 and cardiac arrest. And because right now, if 01:10:42.670 --> 01:10:44.949 you want to go check on what type of doctor Peter 01:10:44.949 --> 01:10:48.710 Antebi is or whatever, you can go on vitals .com 01:10:48.710 --> 01:10:53.670 and find out. It turns out that they sued vitals 01:10:53.670 --> 01:10:56.569 .com and threw so many lawyers at them. Who did? 01:10:56.710 --> 01:10:59.909 The hospitals did. Because they didn't want... 01:11:00.039 --> 01:11:01.760 And they don't want the data to become public. 01:11:01.840 --> 01:11:06.899 So I'm now not naive to tell you that the pharmaceutical 01:11:06.899 --> 01:11:10.600 industry is so big and is so powerful, as is 01:11:10.600 --> 01:11:13.560 the hospital industry. Just as another example, 01:11:13.939 --> 01:11:15.460 the state of Florida had, for the second year 01:11:15.460 --> 01:11:17.520 in a row, a bill going through the House and 01:11:17.520 --> 01:11:21.699 the Senate to try and force hospitals to become 01:11:21.699 --> 01:11:25.659 pediatric ready. Very simple. You find that only 01:11:25.659 --> 01:11:27.720 14 % of hospitals are pediatric ready, and a 01:11:27.720 --> 01:11:29.539 lot of kids are dying every year from non -ready 01:11:29.539 --> 01:11:31.819 hospitals. They put a simple bill in there to 01:11:31.819 --> 01:11:34.180 say, you must do these things to be pediatric 01:11:34.180 --> 01:11:36.779 ready. It was killed again just two days ago 01:11:36.779 --> 01:11:44.720 by the hospital lobby. Okay? So 100 ,000%, there 01:11:44.720 --> 01:11:47.479 are people who want the funds and the revenue 01:11:47.479 --> 01:11:50.260 to keep coming in at the expense of the health 01:11:50.260 --> 01:11:52.590 of the American public. And that's just... That's 01:11:52.590 --> 01:11:55.250 just how it is. And what does that mean to you, 01:11:55.329 --> 01:11:57.729 the listener? You're going to have to go and 01:11:57.729 --> 01:12:00.649 understand this and then take your own actions 01:12:00.649 --> 01:12:03.470 and find the Jesses of the world who are going 01:12:03.470 --> 01:12:06.689 to come and say, I'm going to present to you 01:12:06.689 --> 01:12:09.750 different evidence for a healthier Peter and 01:12:09.750 --> 01:12:11.890 Tevi, and we're going to personalize the care 01:12:11.890 --> 01:12:14.130 for yourself because you're not going to find 01:12:14.130 --> 01:12:15.789 this information anywhere else. And it's just, 01:12:15.829 --> 01:12:18.649 it's unfortunate that that's where we are today, 01:12:18.810 --> 01:12:22.930 that you have to, you know, You, James, have 01:12:22.930 --> 01:12:26.210 to rely on your upbringing and your knowledge 01:12:26.210 --> 01:12:28.270 and know -how because you're never going to get 01:12:28.270 --> 01:12:30.810 the information you know today from a doctor. 01:12:31.329 --> 01:12:33.289 I was never talked out of medical school. I think 01:12:33.289 --> 01:12:34.670 that was a question earlier that I probably didn't 01:12:34.670 --> 01:12:38.050 answer. They never focused on it. No one focused 01:12:38.050 --> 01:12:40.529 on breathing. No one focused on sleep, right? 01:12:40.789 --> 01:12:44.970 Your growth hormone is released in several times 01:12:44.970 --> 01:12:47.329 throughout the day, most importantly at around 01:12:47.329 --> 01:12:51.909 1030. So you probably should be in bed. So that 01:12:51.909 --> 01:12:54.569 growth hormone can do what it's supposed to do 01:12:54.569 --> 01:12:57.770 at that right time. If your sleep is off, everything 01:12:57.770 --> 01:12:59.930 about you is off. That goes back to what you 01:12:59.930 --> 01:13:02.789 focus on in the fire department, where cortisol 01:13:02.789 --> 01:13:05.689 levels are off. All the levels are off when you 01:13:05.689 --> 01:13:08.750 don't get the right sleep. When you go to the 01:13:08.750 --> 01:13:10.569 doctor, they're not asking you, how was your 01:13:10.569 --> 01:13:13.090 sleep? But most of us have, you know, I have 01:13:13.090 --> 01:13:16.090 my aura ring right here. I have my Apple watch. 01:13:16.210 --> 01:13:18.489 Every morning, religiously, I wake up. I want 01:13:18.489 --> 01:13:21.510 to know how I slept last night. And so I now 01:13:21.510 --> 01:13:23.630 focus on my sleep. I try to focus on exercise, 01:13:23.869 --> 01:13:28.369 eating healthy. And I'm doing that without any 01:13:28.369 --> 01:13:30.590 really any help. I'm just trying to figure it 01:13:30.590 --> 01:13:33.109 out on my own, which is unfortunate. Well, you 01:13:33.109 --> 01:13:35.310 mentioned about being in Palm Beach Gardens the 01:13:35.310 --> 01:13:39.850 other day. You're in Palm Beach County. The 24 01:13:39.850 --> 01:13:42.510 -72 revolution is really happening down in your 01:13:42.510 --> 01:13:46.310 area. What are you hearing as far as, you know? 01:13:46.680 --> 01:13:49.140 any kind of rhetoric around this change? And 01:13:49.140 --> 01:13:51.500 then what is your perception if we go all the 01:13:51.500 --> 01:13:54.520 way back to being able to make good medical decisions 01:13:54.520 --> 01:13:58.979 on this kind of movement and the ability to improve 01:13:58.979 --> 01:14:02.220 the paramedic and fireside as far as acuity? 01:14:03.100 --> 01:14:06.199 I'll tell you a story that just happened yesterday. 01:14:06.300 --> 01:14:08.939 I spoke to somebody who was on a 48. Why were 01:14:08.939 --> 01:14:12.180 they on a 48, you ask? And you know the answer. 01:14:12.260 --> 01:14:14.640 It's because they were on overtime, mandatory 01:14:14.640 --> 01:14:19.760 overtime. So now they're at a 48 and they're 01:14:19.760 --> 01:14:24.060 being asked to do things. So we had some crazy 01:14:24.060 --> 01:14:27.739 calls yesterday. A lady who was 24 weeks pregnant 01:14:27.739 --> 01:14:32.680 who is at the OB office. And when the OB looked, 01:14:33.140 --> 01:14:36.199 she sees an amniotic sac with two feet protruding. 01:14:37.000 --> 01:14:41.760 And she's feeling contraction. So just imagine 01:14:41.760 --> 01:14:46.819 if we now had to deliver. or try to deliver a 01:14:46.819 --> 01:14:52.859 footling breach of a 24 -week, you know, a lady 01:14:52.859 --> 01:14:56.479 who's 24 weeks pregnant, and you're on a 48, 01:14:56.880 --> 01:15:04.699 right? Just imagine how your lack of sleep, your 01:15:04.699 --> 01:15:08.000 lack of ability to think cognitively and accurately 01:15:08.000 --> 01:15:11.680 and precisely would then lead you to not perform 01:15:11.680 --> 01:15:15.069 well, right? And then you have a bad outcome. 01:15:15.689 --> 01:15:18.449 And because of your shame and your embarrassment, 01:15:18.609 --> 01:15:21.409 you're not going to tell anybody. And that's 01:15:21.409 --> 01:15:24.829 just another fire that's burning inside your 01:15:24.829 --> 01:15:28.550 brain, telling yourself how badly you performed, 01:15:28.890 --> 01:15:32.250 how incapable you are. And oh, by the way, you're 01:15:32.250 --> 01:15:33.890 going to come back down in 48 hours and do that 01:15:33.890 --> 01:15:37.829 all again. So I've talked to a lot of people 01:15:37.829 --> 01:15:43.619 and everybody. who are the frontline folks doing 01:15:43.619 --> 01:15:48.439 the job, they're all very in favor of it. The 01:15:48.439 --> 01:15:50.239 people who are not in favor, the few people who 01:15:50.239 --> 01:15:51.760 have been in favor of it are obviously the people 01:15:51.760 --> 01:15:53.539 trying to figure out financially what this all 01:15:53.539 --> 01:15:57.039 means, right? And they have their own method 01:15:57.039 --> 01:16:01.439 of calculation. Some of them are not calculating 01:16:01.439 --> 01:16:03.359 in the amount of overtime they're paying currently 01:16:03.359 --> 01:16:06.560 to understand that it's basically a wash when 01:16:06.560 --> 01:16:09.420 you actually get 24 -72s in. They're saying we 01:16:09.420 --> 01:16:11.819 have to hire a whole other shift. They're saying 01:16:11.819 --> 01:16:15.039 that now these paramedics want more money. And 01:16:15.039 --> 01:16:19.739 by the way, they're doing less hours. But, you 01:16:19.739 --> 01:16:21.579 know, you have great unions down here who are 01:16:21.579 --> 01:16:25.779 fighting the good fight and their agencies. Now, 01:16:25.899 --> 01:16:28.859 the nice thing about the 24 -72, and I'm preaching 01:16:28.859 --> 01:16:31.420 to the choir here, is that once one department 01:16:31.420 --> 01:16:34.039 goes to it and then another and then another. 01:16:34.909 --> 01:16:38.409 There's no way that you can't go to 24 -72 because 01:16:38.409 --> 01:16:42.210 you will not get any applicants. And so that's 01:16:42.210 --> 01:16:44.270 the nice thing about this particular change. 01:16:44.710 --> 01:16:48.270 It's going to force everybody to move to it. 01:16:49.130 --> 01:16:51.989 And I think that's something that we're seeing 01:16:51.989 --> 01:16:55.170 already. And it's just going to force people 01:16:55.170 --> 01:16:59.329 in that direction. And now it has to be explained 01:16:59.329 --> 01:17:02.069 well to the general public because, you know, 01:17:02.069 --> 01:17:04.569 there's still... politicians and people out there 01:17:04.569 --> 01:17:07.449 who don't understand the risk that you guys take 01:17:07.449 --> 01:17:11.850 every day, the amount of strain, stress that 01:17:11.850 --> 01:17:16.750 you have on these micro -traumatic calls, which 01:17:16.750 --> 01:17:21.289 I call micro -trauma. And so I think that there 01:17:21.289 --> 01:17:24.109 has to be some folks out there who are explaining 01:17:24.109 --> 01:17:26.770 to the general public why not only do you deserve 01:17:26.770 --> 01:17:30.090 2472, you deserve every dollar, you deserve... 01:17:30.220 --> 01:17:32.260 many more dollars you deserve every dollar of 01:17:32.260 --> 01:17:38.539 pension and um and i you know i can tell you 01:17:38.539 --> 01:17:40.220 because about a year ago i think i told you this 01:17:40.220 --> 01:17:42.439 a year ago i almost died when i was riding with 01:17:42.439 --> 01:17:45.359 the fire department uh we got hit pretty hard 01:17:45.359 --> 01:17:48.819 and um the only reason that i'm alive sitting 01:17:48.819 --> 01:17:51.260 here talking to you today is because i saw the 01:17:51.260 --> 01:17:53.779 car coming the ems captain i was riding with 01:17:53.779 --> 01:17:56.779 didn't see the car and i yelled at the last second 01:17:56.779 --> 01:18:00.930 and they pumped on the brakes Just enough that 01:18:00.930 --> 01:18:02.909 they just demolished the whole front end of this 01:18:02.909 --> 01:18:05.829 SUV instead of coming right into my door at 60 01:18:05.829 --> 01:18:08.489 miles an hour. And I went home that day and I 01:18:08.489 --> 01:18:12.050 said, you know, the general public just does 01:18:12.050 --> 01:18:15.050 not understand what these people do. They just 01:18:15.050 --> 01:18:19.229 don't understand it, period. And I am the biggest 01:18:19.229 --> 01:18:24.539 advocate. I am the biggest cheerleader. I will 01:18:24.539 --> 01:18:27.020 argue about this and fight this and debate anyone 01:18:27.020 --> 01:18:30.640 on this topic for as long as I'm alive, because 01:18:30.640 --> 01:18:33.680 this is really one of the hardest jobs in the 01:18:33.680 --> 01:18:36.380 world. It's one of the most glorifying jobs in 01:18:36.380 --> 01:18:38.260 the world, like yesterday's anaphylaxis case. 01:18:38.760 --> 01:18:41.579 But when things go the other way, you're on the 01:18:41.579 --> 01:18:46.579 other side of that coin. And it's a very hidden, 01:18:46.779 --> 01:18:51.270 I wouldn't call it secretive, but very... It's 01:18:51.270 --> 01:18:53.369 in the shadows because you're supposed to be 01:18:53.369 --> 01:18:57.310 this hero. And how dare you talk about the bad 01:18:57.310 --> 01:18:59.289 parts of your job when you're making all this 01:18:59.289 --> 01:19:01.930 money and you have this great pension. And it's 01:19:01.930 --> 01:19:06.250 this weird space that people are in. And I just 01:19:06.250 --> 01:19:09.350 hope that the 2472s, as they come along, are 01:19:09.350 --> 01:19:11.489 messaged the correct way. And maybe when you 01:19:11.489 --> 01:19:14.250 make your film and your documentaries and your 01:19:14.250 --> 01:19:18.670 docuseries, that could be explained. why that's 01:19:18.670 --> 01:19:20.229 so important. I know that you're going to do 01:19:20.229 --> 01:19:23.010 that. Absolutely. Well, firstly, I appreciate 01:19:23.010 --> 01:19:24.609 your perspective because, I mean, you were right 01:19:24.609 --> 01:19:27.149 in the heart of it. And it's interesting because 01:19:27.149 --> 01:19:29.569 I do a presentation. I'm going to do one at the 01:19:29.569 --> 01:19:33.029 FPF next week. And I don't do it very often at 01:19:33.029 --> 01:19:36.449 all, just when it's a large audience. So I can 01:19:36.449 --> 01:19:39.810 have that force multiplier element. But there's 01:19:39.810 --> 01:19:42.010 one slide and it says, who's to fault? And it's 01:19:42.010 --> 01:19:44.829 a picture of a ladder. And it's, can I ask the 01:19:44.829 --> 01:19:46.949 room? And some of them might say chiefs or unions 01:19:46.949 --> 01:19:50.609 or whatever, but usually they go, all of us? 01:19:50.630 --> 01:19:54.210 I'm like, yes. So take the firefighter that goes 01:19:54.210 --> 01:19:56.310 home, tells everyone, oh, we got the best job 01:19:56.310 --> 01:19:58.189 in the world. I get to work out at the station. 01:19:58.329 --> 01:20:01.050 I only work 10 days a month. And that's bullshit. 01:20:01.770 --> 01:20:04.369 We've been telling this fairy tale for decades. 01:20:04.670 --> 01:20:08.489 When you put it down on paper, we work 56 hours 01:20:08.489 --> 01:20:11.069 a week. That's 16 hours more than the person 01:20:11.069 --> 01:20:13.300 that says we shouldn't give. firefighters more 01:20:13.300 --> 01:20:16.199 time off for example so you know when you actually 01:20:16.199 --> 01:20:19.180 unpack it at every single level every one of 01:20:19.180 --> 01:20:21.340 us has believed the kind of myth so it's not 01:20:21.340 --> 01:20:23.560 blaming it's just getting everyone to go take 01:20:23.560 --> 01:20:27.600 a step back evaluate what we've been saying and 01:20:27.600 --> 01:20:30.140 let's kind of dig into the truth and the fiction 01:20:30.140 --> 01:20:32.600 but then like you said i believe that there's 01:20:32.600 --> 01:20:34.619 a revolution and it's beautiful and i know there's 01:20:34.619 --> 01:20:36.560 a central florida department's getting very close 01:20:36.560 --> 01:20:41.250 to to being the first in our area. And then Gainesville, 01:20:41.250 --> 01:20:43.550 they've had amazing success so far. I know FSU 01:20:43.550 --> 01:20:45.689 is doing studies now in Gainesville and Destin, 01:20:45.729 --> 01:20:47.590 which I'll be hearing the results in a few weeks. 01:20:47.909 --> 01:20:50.909 So yeah, this is really gathering momentum, but 01:20:50.909 --> 01:20:54.090 it is that massive herd of elephants in the room 01:20:54.090 --> 01:20:57.399 that is not the... you know, fix all, but it's 01:20:57.399 --> 01:20:59.380 going to make a huge impact on all the things 01:20:59.380 --> 01:21:00.920 that we've discussed, mental health, physical 01:21:00.920 --> 01:21:03.500 health. I mean, all, all the things. So to hear 01:21:03.500 --> 01:21:05.500 your kind of testimony from being in the heart 01:21:05.500 --> 01:21:07.640 of it as an EMS director, I think that's very 01:21:07.640 --> 01:21:11.439 powerful. Yeah. Yeah. It's a, it's been, it's 01:21:11.439 --> 01:21:13.800 been a really the only way that you can get this 01:21:13.800 --> 01:21:16.100 perspective. And I, let's remember, I was the 01:21:16.100 --> 01:21:19.359 guy in the ER before I got into EMS who I was, 01:21:19.380 --> 01:21:21.399 you know, the only thing I knew about EMS was 01:21:21.399 --> 01:21:25.399 that the double doors would slide open. And another 01:21:25.399 --> 01:21:28.239 stretcher would come in for just more patience 01:21:28.239 --> 01:21:32.020 for me to see. No idea what those folks did. 01:21:33.979 --> 01:21:36.500 I heard the same fairy tale stories that you 01:21:36.500 --> 01:21:41.699 heard. And unfortunately, I'm not on podcasts 01:21:41.699 --> 01:21:44.739 like this talking inside baseball about what 01:21:44.739 --> 01:21:47.220 happens. And I don't think many people are telling 01:21:47.220 --> 01:21:50.899 this story, unfortunately. I find myself not 01:21:50.899 --> 01:21:53.520 going home or at dinner parties telling people 01:21:53.520 --> 01:21:57.199 about, the inside baseball of ems because it 01:21:57.199 --> 01:22:00.880 turns out they have they have their their thought 01:22:00.880 --> 01:22:04.779 process of what it is and then here's i'm going 01:22:04.779 --> 01:22:06.460 to go and pop their bubble and say oh by the 01:22:06.460 --> 01:22:08.500 way it's not they do there's a lot of micro trauma 01:22:08.500 --> 01:22:11.619 there's all this emotional stress and they have 01:22:11.619 --> 01:22:13.460 no sleep and their cortisol levels they don't 01:22:13.460 --> 01:22:17.619 nobody wants to hear that right um and so that's 01:22:17.619 --> 01:22:20.739 that's a problem and that's why um this this 01:22:20.739 --> 01:22:24.130 uh the tv show recently where the the pit there 01:22:24.130 --> 01:22:28.569 that came out, um, was so, um, if you went on 01:22:28.569 --> 01:22:32.909 Twitter, all you saw was finally, I can finally 01:22:32.909 --> 01:22:35.590 explain to people what we really do and what 01:22:35.590 --> 01:22:38.069 my day is really like. And that's, that's, that 01:22:38.069 --> 01:22:39.449 was such an important thing. Cause I did the 01:22:39.449 --> 01:22:41.109 same thing. I'm like, that's what we do right 01:22:41.109 --> 01:22:43.369 there. Yeah. And that's what I hope is kind of 01:22:43.369 --> 01:22:45.050 is going to be for our profession. It's not just 01:22:45.050 --> 01:22:47.550 purely the modern day fire service. It goes back 01:22:47.550 --> 01:22:49.289 in time and all that, but I think this is it. 01:22:49.310 --> 01:22:51.050 And when I saw the pit, I was like, firstly, 01:22:51.850 --> 01:22:54.630 I mean, for example, one of my biggest frustrations 01:22:54.630 --> 01:22:56.710 during COVID is journalists being like, there 01:22:56.710 --> 01:22:58.810 are people in the hallways of the hospitals. 01:22:59.310 --> 01:23:01.729 There are always people in the hallway. Where 01:23:01.729 --> 01:23:03.770 have you been the rest of the time? And the pit 01:23:03.770 --> 01:23:06.329 shows the triage and talks about the hours and 01:23:06.329 --> 01:23:09.390 hours and hours of waits and the assaults on 01:23:09.390 --> 01:23:11.770 medical staff and the mental health issues and 01:23:11.770 --> 01:23:14.609 the fentanyl. And I mean, just it was so well 01:23:14.609 --> 01:23:16.550 done. And then you add in the fact that technically 01:23:16.550 --> 01:23:19.439 they got it spot on as well. I mean, I think 01:23:19.439 --> 01:23:21.840 it was such a breakthrough show. I really do. 01:23:22.479 --> 01:23:26.100 It was. And they had great writers, you know, 01:23:26.180 --> 01:23:30.399 Mel Herbert from MRAP in California, kind of 01:23:30.399 --> 01:23:33.880 legendary educational figure, ER doc, who helped 01:23:33.880 --> 01:23:37.000 them write the show. They had great pediatric 01:23:37.000 --> 01:23:41.180 help, Sylvia from Children's of Pittsburgh. And 01:23:41.180 --> 01:23:45.479 they really dialed it in to the point where even 01:23:45.479 --> 01:23:48.390 for me watching the show, um again i haven't 01:23:48.390 --> 01:23:50.670 done i haven't done a shift in a little bit here 01:23:50.670 --> 01:23:55.329 but um it brought me right back to the my brain 01:23:55.329 --> 01:23:58.630 was hurting after every show of like i remember 01:23:58.630 --> 01:24:00.949 what it was like to come home from a shift and 01:24:00.949 --> 01:24:03.670 be dead to the world after a 12 -hour shift not 01:24:03.670 --> 01:24:06.670 a 24. dead to the world and i didn't want to 01:24:06.670 --> 01:24:08.449 talk to my kids i just wanted to go to bed and 01:24:08.449 --> 01:24:12.670 then it was you know it's it's it's very important 01:24:12.670 --> 01:24:15.829 to show the public what really happens and not 01:24:15.829 --> 01:24:18.239 just to say oh You're an ER doctor. You must 01:24:18.239 --> 01:24:20.560 make a lot of money and not understand really 01:24:20.560 --> 01:24:23.100 what's really happening behind the scenes. Absolutely. 01:24:23.319 --> 01:24:25.100 Well, I want to make sure that we talk about 01:24:25.100 --> 01:24:27.439 whole blood. But while we're on this kind of 01:24:27.439 --> 01:24:30.439 physical mental health in a track, let's talk 01:24:30.439 --> 01:24:32.859 about the mental health in the first responder 01:24:32.859 --> 01:24:35.300 community. Before we hit record, we talked about 01:24:35.300 --> 01:24:37.699 some of the people that we've lost in your area. 01:24:37.840 --> 01:24:42.060 So let's give you the mic on that. Yeah, thanks. 01:24:42.199 --> 01:24:45.760 I appreciate that. I mean, we. This is a huge 01:24:45.760 --> 01:24:49.800 topic for me, so much so that if you come to 01:24:49.800 --> 01:24:51.720 any of the paramedic school graduations, you 01:24:51.720 --> 01:24:53.960 have two schools that I'm medical director for. 01:24:54.220 --> 01:24:57.659 And at the graduation, I have all the family 01:24:57.659 --> 01:25:03.039 there. And I go on about this topic of mental 01:25:03.039 --> 01:25:07.460 health. Then at our department, I mentioned to 01:25:07.460 --> 01:25:08.979 you earlier that we have so many things that 01:25:08.979 --> 01:25:11.020 are happening, even like currently today, yesterday. 01:25:11.880 --> 01:25:13.659 We have people at our departments who are talking 01:25:13.659 --> 01:25:17.100 about, you know, mental health, the value of 01:25:17.100 --> 01:25:19.659 sleep and, you know, really doing things the 01:25:19.659 --> 01:25:21.960 right way and trying to kind of cleanse yourself 01:25:21.960 --> 01:25:27.819 and having, you know, your life in balance with 01:25:27.819 --> 01:25:31.079 religion, with friends, with family, with all 01:25:31.079 --> 01:25:38.300 those things. And unfortunately, it's still a 01:25:38.300 --> 01:25:41.340 problem in our departments. But unfortunately, 01:25:41.560 --> 01:25:44.760 there are people who are in my agencies today 01:25:44.760 --> 01:25:48.199 that are in pain, that are hurting, that are 01:25:48.199 --> 01:25:52.220 under treatment, that are getting care. And I 01:25:52.220 --> 01:25:55.279 always worry that we're not providing them with 01:25:55.279 --> 01:25:59.000 the right resources. And to your point, you know, 01:25:59.079 --> 01:26:02.260 we lost Bill, we lost Alex recently when I say 01:26:02.260 --> 01:26:05.800 we, our South Florida community. And these really 01:26:05.800 --> 01:26:10.399 legendary figures who... by all accounts, have 01:26:10.399 --> 01:26:14.979 had legendary careers, like a career that anybody 01:26:14.979 --> 01:26:20.300 would want. But for some reason, they chose to 01:26:20.300 --> 01:26:24.079 take their own life. And you stop and say to 01:26:24.079 --> 01:26:27.760 yourself, what are we missing? What is it that 01:26:27.760 --> 01:26:30.439 is sitting there right in front of us that we're 01:26:30.439 --> 01:26:34.859 not capturing? And I don't know the answer to 01:26:34.859 --> 01:26:39.720 that, but... You know, these types of things 01:26:39.720 --> 01:26:42.939 worry me because when you have someone like Bill 01:26:42.939 --> 01:26:46.680 Gustin, who the funeral was so big, we went to 01:26:46.680 --> 01:26:48.420 the Kaseya Center. That's where the Miami Heat 01:26:48.420 --> 01:26:53.020 play, right? And we celebrated his life. But 01:26:53.020 --> 01:26:56.199 I wonder how many people were sitting there in 01:26:56.199 --> 01:26:59.819 that room feeling the same way and not being 01:26:59.819 --> 01:27:04.899 able to have an outlet. And so that's why you 01:27:04.899 --> 01:27:08.470 and I have talked about this. maybe we'll talk 01:27:08.470 --> 01:27:10.770 about it here again, which is that there's so 01:27:10.770 --> 01:27:14.289 many more things we could be doing. And so one 01:27:14.289 --> 01:27:15.729 of the things that I know you're very interested 01:27:15.729 --> 01:27:17.829 in, but something that we've actually implemented 01:27:17.829 --> 01:27:20.670 here in both Broward and Palm Beach is the access 01:27:20.670 --> 01:27:26.529 to ketamine. And this is for someone who's acutely 01:27:26.529 --> 01:27:30.930 suicidal, who we know there's data to show that 01:27:30.930 --> 01:27:33.430 ketamine can help you if you get it like today. 01:27:34.409 --> 01:27:36.270 But if there's all these barriers or people are 01:27:36.270 --> 01:27:38.630 not knowledgeable about it or they think ketamine 01:27:38.630 --> 01:27:43.270 has killed Matthew Perry or whatever, then they 01:27:43.270 --> 01:27:45.609 end up kind of putting all these barriers. And 01:27:45.609 --> 01:27:48.890 then you have these people who need it, you know, 01:27:48.909 --> 01:27:51.289 paramedics, firefighters who need it, but don't 01:27:51.289 --> 01:27:54.529 have access to it. It's up to us as the leaders 01:27:54.529 --> 01:27:56.649 of the department to say, no, we're going to 01:27:56.649 --> 01:27:58.770 educate you on this thing. We're going to provide 01:27:58.770 --> 01:28:02.319 immediate access to people to. ketamine, obviously 01:28:02.319 --> 01:28:05.560 plus therapy at the same time. And now all the 01:28:05.560 --> 01:28:07.180 other treatments that are coming down the pipe. 01:28:07.619 --> 01:28:11.079 Why should we not have access to that? Why should 01:28:11.079 --> 01:28:14.020 there be any stigma to a firefighter going and 01:28:14.020 --> 01:28:18.060 getting, you know, the six to 10 ketamine infusions 01:28:18.060 --> 01:28:20.460 over the three week period? There shouldn't be 01:28:20.460 --> 01:28:24.619 any stigma to that, but people are slow to adopt, 01:28:24.760 --> 01:28:28.279 but this is the future. You know, every department 01:28:28.279 --> 01:28:32.090 in America. At some point in the future, we'll 01:28:32.090 --> 01:28:36.850 have access to these other things that are currently 01:28:36.850 --> 01:28:39.970 today not being given. We're just not giving 01:28:39.970 --> 01:28:43.550 them access to things that we know work, that 01:28:43.550 --> 01:28:45.590 they're studied with veterans that we know work. 01:28:47.229 --> 01:28:49.489 And maybe it's big pharma that's stopping it. 01:28:49.569 --> 01:28:52.670 I don't know. Things have to change. And I know 01:28:52.670 --> 01:28:54.369 that you're much more into that world than I 01:28:54.369 --> 01:28:57.670 am, but I'm a very big proponent of that, and 01:28:57.670 --> 01:28:59.409 I'm going to keep fighting for that for my folks 01:28:59.409 --> 01:29:01.909 so we don't have any more deaths that are unnecessary. 01:29:02.930 --> 01:29:04.829 Well, going back to the big pharma, I think a 01:29:04.829 --> 01:29:07.789 good example of the, for lack of a better word, 01:29:07.829 --> 01:29:13.029 fuckery behind the scenes is the FDA refused 01:29:13.029 --> 01:29:17.220 or denied. mdma to be used again as a therapeutic 01:29:17.220 --> 01:29:19.399 you know not that you just get prescribed and 01:29:19.399 --> 01:29:21.460 go dance around the streets but you sit down 01:29:21.460 --> 01:29:24.739 with a counselor but you know oxycontin was approved 01:29:24.739 --> 01:29:27.359 by fda and look what happened there you know 01:29:27.359 --> 01:29:30.359 so the way i see this you know firstly as far 01:29:30.359 --> 01:29:33.300 as contributing factors it's a new a number of 01:29:33.300 --> 01:29:35.779 things and we all know for example sleep deprivation 01:29:35.779 --> 01:29:38.760 is a massive contributor to mental ill health 01:29:38.760 --> 01:29:41.689 so that's an easy easy thing to start making 01:29:41.689 --> 01:29:45.170 a big difference is to give our first responders 01:29:45.170 --> 01:29:47.529 more rest and recovery. You've got unaddressed 01:29:47.529 --> 01:29:49.430 childhood trauma. Okay, well, at the front door, 01:29:49.510 --> 01:29:52.189 rather than doing the MMPI, which does nothing, 01:29:52.390 --> 01:29:55.550 let's have counseling from day one. Let's give 01:29:55.550 --> 01:29:58.310 our probies, as well as the PT, let's give them 01:29:58.310 --> 01:30:00.710 mental PT and give them an opportunity to offload. 01:30:00.789 --> 01:30:03.090 Because if you became a first responder, there's 01:30:03.090 --> 01:30:05.130 a good chance that you had some struggles when 01:30:05.130 --> 01:30:07.090 you were younger. That's what makes you a good 01:30:07.090 --> 01:30:09.810 firefighter or cop. but only you have to address 01:30:09.810 --> 01:30:11.670 them. You have to work through them so you can 01:30:11.670 --> 01:30:14.590 grow from them. But then from the therapeutics, 01:30:14.609 --> 01:30:17.130 the kind of analogy I've come up with is you're 01:30:17.130 --> 01:30:19.310 standing in front of the closet in your mind 01:30:19.310 --> 01:30:22.569 and maybe talk therapy just wasn't the right 01:30:22.569 --> 01:30:25.010 key for the lock. And so you're still standing 01:30:25.010 --> 01:30:27.390 outside. You haven't got to the thing. So maybe 01:30:27.390 --> 01:30:32.149 it's MDMA or psilocybin or ibogaine or ketamine 01:30:32.149 --> 01:30:34.510 that allows you to open that door. And as you 01:30:34.510 --> 01:30:38.319 pointed out, not alone. alongside with psychotherapy. 01:30:38.439 --> 01:30:40.880 Now you've opened it. Now you can start unpacking 01:30:40.880 --> 01:30:42.840 what's inside. And I think that's what we have 01:30:42.840 --> 01:30:45.420 to understand is that some people, yeah, will 01:30:45.420 --> 01:30:46.960 be able to walk into a room. They'll have a good, 01:30:46.960 --> 01:30:48.939 good relationship with a counselor and they'll 01:30:48.939 --> 01:30:51.579 be able to unload some things. And then that's 01:30:51.579 --> 01:30:53.880 it. A lot of people I know have breakthroughs 01:30:53.880 --> 01:30:55.439 because they didn't even realize it was in there. 01:30:55.789 --> 01:30:58.449 It was so far locked away deep in their mind. 01:30:58.510 --> 01:31:00.850 And this is what ketamine and some of these other 01:31:00.850 --> 01:31:03.750 substances that were so demonized in the past 01:31:03.750 --> 01:31:06.510 are showing to have amazing success. It's not 01:31:06.510 --> 01:31:09.829 a magic bullet, but it opens the door to whatever 01:31:09.829 --> 01:31:12.569 recess of your mind that now you can get to that 01:31:12.569 --> 01:31:15.090 to use the princess and a pea analogy, the pea 01:31:15.090 --> 01:31:19.329 beneath the mattress. I agree with you. And I 01:31:19.329 --> 01:31:23.079 also think that. This is where the AI is going 01:31:23.079 --> 01:31:26.439 to come in in a huge way because you'll be able 01:31:26.439 --> 01:31:31.020 to have an AI that is able to provide feedback, 01:31:31.720 --> 01:31:34.060 conversations, along with these other types of 01:31:34.060 --> 01:31:38.659 treatments. And I think we're, you know, listen, 01:31:38.699 --> 01:31:41.840 I've referred so many people to these ketamine 01:31:41.840 --> 01:31:44.140 clinics here in our area. I visited all the ketamine 01:31:44.140 --> 01:31:46.600 clinics myself. I shook their hands. I learned 01:31:46.600 --> 01:31:48.699 their process. I learned who they were, how they 01:31:48.699 --> 01:31:51.350 were trained, what their process is. where the 01:31:51.350 --> 01:31:56.289 data is so now we we you know um we allow folks 01:31:56.289 --> 01:31:58.710 to and again i know there's more than ketamine 01:31:58.710 --> 01:32:00.930 but for now at least i don't have any access 01:32:00.930 --> 01:32:04.609 to the psilocybin to the mdma you know therapeutics 01:32:04.609 --> 01:32:09.689 if you will but um the world has changed from 01:32:09.689 --> 01:32:12.029 when you and i were younger and from when our 01:32:12.029 --> 01:32:15.869 parents were younger and um a great book that 01:32:15.869 --> 01:32:20.579 that i read was um by a guy named Yuval Harari. 01:32:20.680 --> 01:32:24.199 He wrote the book Sapiens, which is a great book. 01:32:24.460 --> 01:32:26.579 Then the book that really hit me was Homo Deus. 01:32:27.619 --> 01:32:32.439 He talks about why kids growing up today are 01:32:32.439 --> 01:32:34.760 going to have massive amounts of anxiety and 01:32:34.760 --> 01:32:37.939 stress compared to when we were younger. A lot 01:32:37.939 --> 01:32:41.180 of it has to do with social media and all that's 01:32:41.180 --> 01:32:46.479 out there today. change what we've done for the 01:32:46.479 --> 01:32:50.119 last 50, 60 years. And we have to retool for 01:32:50.119 --> 01:32:51.979 what's coming, what's actually here already, 01:32:52.100 --> 01:32:55.899 and use the different tools, whether it be different 01:32:55.899 --> 01:33:00.920 therapeutics, AI, different mechanisms, different 01:33:00.920 --> 01:33:04.600 work schedules. We really have to completely 01:33:04.600 --> 01:33:07.699 start from a blank slate now that we understand 01:33:07.699 --> 01:33:11.239 more of the science and say, this is the way 01:33:11.239 --> 01:33:12.819 we're going to walk into the future. And that's 01:33:12.819 --> 01:33:16.159 hard for a lot of people. to do you and i are 01:33:16.159 --> 01:33:18.319 different and people listening to this podcast 01:33:18.319 --> 01:33:20.079 are probably different but there are a lot of 01:33:20.079 --> 01:33:21.979 people who just do things because that's the 01:33:21.979 --> 01:33:26.479 way we've always done it and that mentality is 01:33:26.479 --> 01:33:28.520 going to have to change and it's going to take 01:33:28.520 --> 01:33:32.000 ground roots effort and people to just change 01:33:32.000 --> 01:33:35.000 it and then study it and publish it and then 01:33:35.000 --> 01:33:38.119 over time i think we'll be in a place maybe in 01:33:38.119 --> 01:33:42.100 five to ten years from now where this conversation 01:33:42.100 --> 01:33:44.039 will be very different than the conversation 01:33:44.039 --> 01:33:45.960 we had today and the one we had 10 years ago. 01:33:46.579 --> 01:33:48.760 Absolutely. I was talking to someone yesterday, 01:33:49.119 --> 01:33:52.199 Mike Cleland, the firefighter turned lawyer. 01:33:52.819 --> 01:33:55.420 And I've been saying this recently, you know, 01:33:55.439 --> 01:33:58.060 when we talk about the Bill Gustins and all the 01:33:58.060 --> 01:34:00.819 pioneers of the past, they came up with bunker 01:34:00.819 --> 01:34:04.220 gear, SCBAs, you know, easy IOs. I mean, whatever, 01:34:04.399 --> 01:34:05.840 you know, obviously you're one of them with the 01:34:05.840 --> 01:34:09.340 hand heavy system, but operationally, there's 01:34:09.340 --> 01:34:11.630 a lot of things that are already. they're working 01:34:11.630 --> 01:34:13.789 pretty well like a hose is a hose a ladder is 01:34:13.789 --> 01:34:16.689 a ladder you know we've kind of got most of those 01:34:16.689 --> 01:34:19.949 my generation our generation i think what we 01:34:19.949 --> 01:34:23.550 can do as pioneers is change the human side the 01:34:23.550 --> 01:34:26.750 shifts themselves the access to therapeutics 01:34:26.750 --> 01:34:29.590 the fitness standards all these things so we've 01:34:29.590 --> 01:34:32.250 got the operational side and we've got the guys 01:34:32.250 --> 01:34:34.350 that will show you how to you know use a forcible 01:34:34.350 --> 01:34:37.010 entry prop but now we need to help the person 01:34:37.010 --> 01:34:38.890 in the bunker gear and i think this is where 01:34:39.359 --> 01:34:43.060 my generation, like I said, the kind of 9 -11 01:34:43.060 --> 01:34:45.880 -ish firefighters is what can we leave? What 01:34:45.880 --> 01:34:48.079 legacy can we leave? And I think it's let's make 01:34:48.079 --> 01:34:51.220 it healthy for the next group. Let's make suicide, 01:34:51.300 --> 01:34:54.619 cancer, all these heart disease an anomaly rather 01:34:54.619 --> 01:34:57.140 than an almost certainty that we're seeing at 01:34:57.140 --> 01:35:00.560 the moment. Yeah, I agree with you. I hope for 01:35:00.560 --> 01:35:03.779 that day to happen. Every year there's a walk 01:35:03.779 --> 01:35:07.039 here in Miami called Never Walk Alone. And it's 01:35:07.039 --> 01:35:09.909 because There was a firefighter from the city 01:35:09.909 --> 01:35:15.210 of Miami who took his own life. And, you know, 01:35:15.329 --> 01:35:18.970 it's unfortunate, but we have to continue to 01:35:18.970 --> 01:35:21.750 shine light on this problem. You do an amazing 01:35:21.750 --> 01:35:24.489 job on that, and I hope you continue to do that. 01:35:24.630 --> 01:35:27.890 And we have to kind of be – we have to be your 01:35:27.890 --> 01:35:31.390 force multiplier. And so as many people who are 01:35:31.390 --> 01:35:34.750 listening today, you have to kind of fight the 01:35:34.750 --> 01:35:38.689 fight with James. It's just like with me. I realized 01:35:38.689 --> 01:35:43.250 that just because I wanted to change the world 01:35:43.250 --> 01:35:45.609 of pediatrics, it didn't mean that I was going 01:35:45.609 --> 01:35:48.430 to have people jump on the bus with me. And I've 01:35:48.430 --> 01:35:52.189 learned that the only way things are going to 01:35:52.189 --> 01:35:55.069 change is, unfortunately, when you have all these 01:35:55.069 --> 01:35:56.930 people at the very top who are trying to stop 01:35:56.930 --> 01:36:01.590 this type of innovation, it takes this groundswell, 01:36:01.770 --> 01:36:06.489 grassroots efforts to just one by one, one person 01:36:06.489 --> 01:36:08.840 at a time. is going to change the world. And 01:36:08.840 --> 01:36:10.979 I fully strongly believe that today. I never 01:36:10.979 --> 01:36:13.539 used to believe it. And that's why when people 01:36:13.539 --> 01:36:16.000 ask me to go speak, and I still do a lot of speaking 01:36:16.000 --> 01:36:18.539 engagements, even if there's one person in the 01:36:18.539 --> 01:36:21.859 room, I'll speak to them. Because if that's the 01:36:21.859 --> 01:36:25.500 one person who's going to be able to go and change 01:36:25.500 --> 01:36:28.239 their community, then it's worth it for me. So 01:36:28.239 --> 01:36:33.539 I still like doing things that don't scale. Because 01:36:33.539 --> 01:36:38.340 I think it's You know, until you get to that 01:36:38.340 --> 01:36:42.460 flywheel going, it takes a lot of hand -to -hand 01:36:42.460 --> 01:36:45.239 combat. You've been doing this for a long time 01:36:45.239 --> 01:36:46.760 and you're finally seeing the flywheel moving. 01:36:47.520 --> 01:36:50.319 In healthcare and in anything we do, nothing 01:36:50.319 --> 01:36:52.899 happens overnight. And you could be a TikTok 01:36:52.899 --> 01:36:55.680 celebrity or a YouTube star or whatever, but 01:36:55.680 --> 01:36:58.520 if you want to make the world change, you really 01:36:58.520 --> 01:37:02.420 have to go find that one person and 10 more people 01:37:02.420 --> 01:37:04.890 and 100 more people. And in 10 years from now, 01:37:04.949 --> 01:37:08.409 you'll have 200 ,000 people who believe in what 01:37:08.409 --> 01:37:10.409 you're doing. And then they're going to be the 01:37:10.409 --> 01:37:13.590 future leaders of this place. And then they're 01:37:13.590 --> 01:37:15.390 going to enact the right things. And I think 01:37:15.390 --> 01:37:17.789 that's where we're in that place now where this 01:37:17.789 --> 01:37:21.029 next generation is cycling through. And they 01:37:21.029 --> 01:37:24.470 understand the problem differently. They see 01:37:24.470 --> 01:37:27.109 the solutions differently. And now they're going 01:37:27.109 --> 01:37:30.050 to enact and engage very differently than their 01:37:30.050 --> 01:37:32.609 predecessors did. And I hope that. you continue 01:37:32.609 --> 01:37:35.289 along that path because you've made big impacts 01:37:35.289 --> 01:37:37.909 thus far. Yeah, I agree. I mean, vice versa. 01:37:38.310 --> 01:37:40.630 It's all the people that have been beating the 01:37:40.630 --> 01:37:42.250 drums. Like you said, there's just a knowing 01:37:42.250 --> 01:37:46.010 of the truth. And I think mine comes from hundreds, 01:37:46.069 --> 01:37:48.989 over a thousand interviews. And it's not that 01:37:48.989 --> 01:37:50.890 I'm an intelligent person at all, but when you've 01:37:50.890 --> 01:37:52.670 listened to so many people, yourself included, 01:37:52.850 --> 01:37:55.829 and you see the overlap on the Venn diagram. 01:37:56.510 --> 01:37:58.810 It's irrefutable by that point. And so that's 01:37:58.810 --> 01:38:01.609 really what drives me. Speaking of progressive, 01:38:01.850 --> 01:38:04.050 I just want to hit one more area before we wrap 01:38:04.050 --> 01:38:06.829 up with some closing questions. Talk to me about 01:38:06.829 --> 01:38:09.289 whole blood. That seems to be the next, you know, 01:38:09.289 --> 01:38:13.130 exciting innovation in pre -hospital care. Yeah, 01:38:13.170 --> 01:38:17.350 it is. It is. And I'm just excited to be on this 01:38:17.350 --> 01:38:20.949 journey. And I tell all my firefighter paramedics, 01:38:20.989 --> 01:38:24.409 I said, you're going to be talking to your children 01:38:24.409 --> 01:38:27.970 one day. And you're going to say, you know, your 01:38:27.970 --> 01:38:31.649 mom or your dad, we were one of the first people 01:38:31.649 --> 01:38:32.829 to give whole blood. And they're going to be 01:38:32.829 --> 01:38:34.970 like, come on, there's no way that whole blood 01:38:34.970 --> 01:38:39.409 wasn't around forever. So we're in this moment 01:38:39.409 --> 01:38:41.989 where, and I think we started with this, where 01:38:41.989 --> 01:38:44.710 there are certain things that when I learn about 01:38:44.710 --> 01:38:48.609 them and I see them, that they're so obvious 01:38:48.609 --> 01:38:52.649 to me that it's the future, but that for some 01:38:52.649 --> 01:38:54.329 reason the rest of the world doesn't see it yet. 01:38:55.710 --> 01:38:58.270 I got to give a lot of credit to Don Jenkins, 01:38:58.609 --> 01:39:01.510 John Holcomb, Phil Spinella, Randy Schaefer, 01:39:01.710 --> 01:39:05.250 all like the OGs, you know, C .J. Winkler, who 01:39:05.250 --> 01:39:07.149 actually brought it from the military. They fought 01:39:07.149 --> 01:39:08.930 like hell to get it into the civilian world. 01:39:09.670 --> 01:39:12.949 And then in 2019, we went and said, we want to 01:39:12.949 --> 01:39:14.310 copy everything you're doing. And they said, 01:39:14.369 --> 01:39:17.829 here, open book. And once we started giving whole 01:39:17.829 --> 01:39:21.229 blood, so July of 2022, Palm Beach County, we 01:39:21.229 --> 01:39:24.460 gave our first whole blood. And we had medics 01:39:24.460 --> 01:39:27.180 who were going to retire, you know, I'm not sure 01:39:27.180 --> 01:39:28.819 if I want to go into the drop, blah, blah, blah. 01:39:29.340 --> 01:39:32.760 And then we started saving lives with whole blood. 01:39:33.439 --> 01:39:35.920 Those people never want to retire. Like literally, 01:39:36.079 --> 01:39:40.100 it is from a mental wellness thing. We had a 01:39:40.100 --> 01:39:41.819 four -year -old kid in Palm Beach Gardens who 01:39:41.819 --> 01:39:45.939 was in it. And I put this on LinkedIn a few months 01:39:45.939 --> 01:39:49.420 ago. He was in a booster seat in the back. They 01:39:49.420 --> 01:39:52.350 got hit from behind a 995 at high speed. This 01:39:52.350 --> 01:39:55.569 kid ended up by the dashboard, still in his booster 01:39:55.569 --> 01:39:58.850 seat. It crushed his leg to the point where it 01:39:58.850 --> 01:40:02.029 snapped his femur, right femur snapped. No head 01:40:02.029 --> 01:40:06.149 injury, no chest or abdominal injury, just a 01:40:06.149 --> 01:40:09.569 femur fracture. Ashley, one of our EMS captains, 01:40:09.569 --> 01:40:12.550 gets there on the highway. This kid is now unconscious, 01:40:12.810 --> 01:40:17.550 and he's braiding down. She has been doing this 01:40:17.550 --> 01:40:19.250 for a long time, and she will tell you that she's 01:40:19.250 --> 01:40:21.810 held lots of people in her arms who have died. 01:40:21.930 --> 01:40:24.729 In the same exact situation from hemorrhage on 01:40:24.729 --> 01:40:26.989 the scene, that were alive who died in her arms. 01:40:27.609 --> 01:40:31.050 She gets that whole blood out. She uses this 01:40:31.050 --> 01:40:33.630 LifeFlow infuser. It's an amazing product. And 01:40:33.630 --> 01:40:39.569 she gives him the right dose right on I -95. 01:40:39.869 --> 01:40:42.729 And the kid literally wakes up, okay, starts 01:40:42.729 --> 01:40:45.560 screaming. Starts going towards the hospital, 01:40:45.659 --> 01:40:47.739 you know, 20 minute ride to the hospital. 10 01:40:47.739 --> 01:40:50.000 minutes in, kid's braiding down one more time. 01:40:50.220 --> 01:40:53.420 She gives the next dose of whole blood. Kid wakes 01:40:53.420 --> 01:40:57.180 up, gets to the hospital. Kid's wide awake. Goes 01:40:57.180 --> 01:41:01.260 to the OR, external fixator. He's out of the 01:41:01.260 --> 01:41:03.760 hospital like a week later. Perfectly normal. 01:41:04.539 --> 01:41:07.199 If I would show you the text, I would just show 01:41:07.199 --> 01:41:09.979 you. And by the way, I have like dozens and dozens 01:41:09.979 --> 01:41:13.239 of these texts. And I'm not asking for the text. 01:41:13.359 --> 01:41:16.100 They're just sending it to me because everyone 01:41:16.100 --> 01:41:17.939 knows that I've been so involved in Whole Blood. 01:41:18.020 --> 01:41:21.340 They're like, Doc, this was the most amazing 01:41:21.340 --> 01:41:25.859 feeling I've ever had in my career. I can't believe 01:41:25.859 --> 01:41:27.800 that we're able to do this. Thank you so much. 01:41:27.800 --> 01:41:34.039 This is the most incredible, amazing. It's people 01:41:34.039 --> 01:41:35.800 who have been doing this for a long, long, long 01:41:35.800 --> 01:41:38.399 time. who are finally getting people back to 01:41:38.399 --> 01:41:40.380 life who are dying in their arms. And now we 01:41:40.380 --> 01:41:42.939 have the data to prove it. So from New Orleans 01:41:42.939 --> 01:41:45.079 to Washington, D .C. to Atlanta to Palm Beach 01:41:45.079 --> 01:41:47.760 to Broward County, all of us have about a 90 01:41:47.760 --> 01:41:51.539 % survival rate if we got the blood before you 01:41:51.539 --> 01:41:53.640 were in cardiac arrest. If you were in a cardiac 01:41:53.640 --> 01:41:55.760 arrest already, Palm Beach County, we have a 01:41:55.760 --> 01:41:59.560 0 % survival, unfortunately. But 90 % survival 01:41:59.560 --> 01:42:03.460 for everybody else. You know what that is? So 01:42:03.460 --> 01:42:06.739 that's number one. So whole blood is here. The 01:42:06.739 --> 01:42:08.560 only things that people should be understanding 01:42:08.560 --> 01:42:11.479 of, and it's a whole other podcast we can have, 01:42:11.579 --> 01:42:13.539 which is that there's not enough whole blood 01:42:13.539 --> 01:42:18.739 today to supply every EMS system. So that part 01:42:18.739 --> 01:42:20.979 of the equation has to be fixed. And there's 01:42:20.979 --> 01:42:22.279 a lot of things we can do. I'm not going to go 01:42:22.279 --> 01:42:26.380 into that today. But what's coming in spring 01:42:26.380 --> 01:42:29.939 of 2026 is something even more amazing, which 01:42:29.939 --> 01:42:32.539 is a company who has figured out how to spray 01:42:32.539 --> 01:42:36.630 dry plasma. So the whole blood costs us about 01:42:36.630 --> 01:42:39.989 $650 per unit. All the consumables cost us another 01:42:39.989 --> 01:42:44.050 $300. We're in for about $1 ,000 a patient. This 01:42:44.050 --> 01:42:48.670 plasma thing, they take this plasma, which is 01:42:48.670 --> 01:42:51.609 the yellow fluid that bathes the red blood cells 01:42:51.609 --> 01:42:54.710 in the platelets. They isolate the plasma. This 01:42:54.710 --> 01:42:57.409 company has figured out a process to dehydrate 01:42:57.409 --> 01:43:00.550 the plasma, put it into a moisture -free bag. 01:43:01.100 --> 01:43:03.699 in crystals. So imagine having like a normal 01:43:03.699 --> 01:43:06.279 saline bag that's completely empty and it feels 01:43:06.279 --> 01:43:08.600 empty. It feels paperweight. It comes with a 01:43:08.600 --> 01:43:13.720 200 ml sterile water bag that you add it to the 01:43:13.720 --> 01:43:16.039 crystals at the time of use. It takes about four 01:43:16.039 --> 01:43:18.359 minutes. And now you have a full bag of plasma 01:43:18.359 --> 01:43:20.399 with all the factors, all the clotting factors, 01:43:20.460 --> 01:43:24.060 all the proteins you need. And you'll use it 01:43:24.060 --> 01:43:29.420 for trauma, TBI, anaphylaxis, sepsis, burns. 01:43:30.520 --> 01:43:32.460 And you're using a real blood product that has 01:43:32.460 --> 01:43:35.199 a two -year shelf life that's going to cost somewhere 01:43:35.199 --> 01:43:39.260 around $100. And that's going to be massively 01:43:39.260 --> 01:43:44.220 available. And so whole blood and plasma, which, 01:43:44.279 --> 01:43:45.739 by the way, I have both of those live today. 01:43:45.939 --> 01:43:48.020 The plasma I'm using today is liquid plasma, 01:43:48.279 --> 01:43:52.000 $60. So if you get into an accident in Palm Beach 01:43:52.000 --> 01:43:53.420 County and you have a traumatic brain injury, 01:43:53.640 --> 01:43:55.760 you're going to get plasma. If you're hemorrhaging 01:43:55.760 --> 01:44:00.439 because you got stabbed, shot. a car accident, 01:44:00.659 --> 01:44:03.859 you're going to get whole blood. And I got to 01:44:03.859 --> 01:44:06.880 give credit to my leadership. I got to give credit 01:44:06.880 --> 01:44:08.479 to my fire chief. I got to give credit to the 01:44:08.479 --> 01:44:11.239 county commissioners because we are paying for 01:44:11.239 --> 01:44:14.399 all this, right? We're not getting paid back. 01:44:14.579 --> 01:44:16.500 It goes back to the conversation we started off 01:44:16.500 --> 01:44:19.680 with, which is that we are spending a thousand 01:44:19.680 --> 01:44:22.680 bucks. We're collecting maybe 400 if we're lucky. 01:44:23.199 --> 01:44:27.060 And the federal government is saying, you know, 01:44:27.060 --> 01:44:29.189 sorry, can't help you. I mean, There are people 01:44:29.189 --> 01:44:31.949 trying to make moves to change that. But the 01:44:31.949 --> 01:44:33.890 hospital, that same hospital who would have given 01:44:33.890 --> 01:44:36.130 the same whole blood would have charged, you 01:44:36.130 --> 01:44:39.189 know, six grand to the insurance company. They 01:44:39.189 --> 01:44:42.210 would have made hundreds of thousands of dollars 01:44:42.210 --> 01:44:45.529 on those patients. But the social care, socialized 01:44:45.529 --> 01:44:48.729 medicine, the safety net of the community is 01:44:48.729 --> 01:44:55.109 losing money. So I am here not only to push this 01:44:55.109 --> 01:44:58.039 concept of whole blood and plasma. But the push 01:44:58.039 --> 01:45:02.199 that the fact that EMS is the life -saving unit 01:45:02.199 --> 01:45:04.840 in our communities, we're giving antibiotics 01:45:04.840 --> 01:45:07.159 for sepsis, which has never been done before, 01:45:07.359 --> 01:45:09.420 which is going to, once the studies come out, 01:45:09.500 --> 01:45:11.659 and I just published my study, but once a big 01:45:11.659 --> 01:45:15.680 RCT from Canada comes out, next year, everybody's 01:45:15.680 --> 01:45:17.560 going to be moving to antibiotics for sepsis. 01:45:18.119 --> 01:45:20.279 We do finger thoracoscopy. We use ultrasound, 01:45:20.539 --> 01:45:23.600 the whole blood, the plasma. Look at all the 01:45:23.600 --> 01:45:26.430 stuff that EMS is doing. The rest of the world, 01:45:26.489 --> 01:45:29.409 the rest of healthcare doesn't get it because 01:45:29.409 --> 01:45:31.369 they have the blinders on. When they hear EMS, 01:45:31.529 --> 01:45:34.069 they shut their brain down and they have no concept 01:45:34.069 --> 01:45:36.949 of what we do. I'm trying to change that by getting 01:45:36.949 --> 01:45:39.649 more out there on social media to try and expose 01:45:39.649 --> 01:45:43.189 what your EMS system can do. But it's going to 01:45:43.189 --> 01:45:44.789 rely on the people listening to this podcast 01:45:44.789 --> 01:45:46.989 who don't have those things to go fight like 01:45:46.989 --> 01:45:49.609 hell to get it. To go fight like hell to change 01:45:49.609 --> 01:45:52.310 the 24 -72. To fight like hell to get whole blood 01:45:52.310 --> 01:45:55.180 and plasma. To fight like hell for the profession 01:45:55.180 --> 01:46:01.039 that you love, right? And I think it's happening. 01:46:01.399 --> 01:46:04.420 And I'm hoping that I can continue to inspire 01:46:04.420 --> 01:46:08.579 more people to really own it, that we are the 01:46:08.579 --> 01:46:10.460 people who are the ones who are saving lives. 01:46:11.260 --> 01:46:15.260 The hospital just takes the baton and they keep 01:46:15.260 --> 01:46:18.350 that alive person alive, hopefully. enough for 01:46:18.350 --> 01:46:20.810 them to walk out of the hospital so it's an it's 01:46:20.810 --> 01:46:23.289 an amazing profession the people are just incredible 01:46:23.289 --> 01:46:27.390 salt of the earth common sense just great people 01:46:27.390 --> 01:46:30.390 and i have really found the place where i need 01:46:30.390 --> 01:46:34.350 to be in life and i'm just very grateful to know 01:46:34.350 --> 01:46:36.649 people like you and to try to spread the word 01:46:36.649 --> 01:46:40.770 when i kind of reflected back as i got deeper 01:46:40.770 --> 01:46:43.510 into my career Some of the things that we were 01:46:43.510 --> 01:46:45.170 told, you know, that's the way we've always done 01:46:45.170 --> 01:46:47.350 it. I question. So I'll give you a fire example, 01:46:47.630 --> 01:46:50.909 a car fire. I've never seen someone drive up 01:46:50.909 --> 01:46:53.029 to a fire station and say, thank you for saving 01:46:53.029 --> 01:46:56.170 my car. I got it all restored and here it is. 01:46:56.390 --> 01:46:59.270 Like every car fire is a dumpster fire, but it's 01:46:59.270 --> 01:47:01.989 also a class B dumpster fire. So it's a, you 01:47:01.989 --> 01:47:04.729 know, petroleum dumpster fire, yet we use war. 01:47:04.930 --> 01:47:06.850 And I've watched, you know, numerous times using 01:47:06.850 --> 01:47:09.310 the entire tank of engine war, just to try and 01:47:09.310 --> 01:47:12.069 put out a fire as the, the petrol was kind of, 01:47:12.069 --> 01:47:14.109 you know, going down into the drain, still on 01:47:14.109 --> 01:47:17.750 fire. And, you know, so. And clearly, when you 01:47:17.750 --> 01:47:20.050 put foam on it, it goes out straight away. Or 01:47:20.050 --> 01:47:22.210 even people laugh at it, but the Europeans have 01:47:22.210 --> 01:47:24.529 a blanket. They'll carry over, and it goes out. 01:47:24.989 --> 01:47:27.670 Now, that's not the lithium -ion batteries. That's 01:47:27.670 --> 01:47:30.710 another entire thing. But we were always told, 01:47:30.810 --> 01:47:32.289 put water on it. But then when you're in fire 01:47:32.289 --> 01:47:34.270 school, water is for paper and wood. It just 01:47:34.270 --> 01:47:35.770 doesn't make any sense. And you're not saving 01:47:35.770 --> 01:47:37.369 anything, so you don't need to be right up on 01:47:37.369 --> 01:47:40.010 it either. On an EMS point of view, I'm not the 01:47:40.010 --> 01:47:42.130 smartest tool in the box, or the sharpest tool 01:47:42.130 --> 01:47:43.630 in the box. I can't even say that phrase right. 01:47:45.439 --> 01:47:48.359 I always remember thinking with the trauma, if 01:47:48.359 --> 01:47:50.960 we're adding saline and there's no red blood 01:47:50.960 --> 01:47:54.300 cells in saline, why are we adding saline? You're 01:47:54.300 --> 01:47:57.180 just diluting the blood. And this was a long 01:47:57.180 --> 01:48:00.340 time ago, I was thinking this. So talk to me 01:48:00.340 --> 01:48:04.100 about the pushback from the naysayers. And then 01:48:04.100 --> 01:48:06.520 also I'd love to hear what is the gold standard? 01:48:06.699 --> 01:48:09.039 Because I had someone on recently, they didn't 01:48:09.039 --> 01:48:11.619 have it on their... on their ambulances, but 01:48:11.619 --> 01:48:15.699 they had it on the helicopters. So what is the 01:48:15.699 --> 01:48:19.800 ideal? Is it blood on every rig? So I guess, 01:48:19.800 --> 01:48:22.079 firstly, how did you overcome the opposition? 01:48:22.359 --> 01:48:24.140 What was the opposition? And then what is the 01:48:24.140 --> 01:48:26.260 gold standard that we're all aiming for in an 01:48:26.260 --> 01:48:30.319 agency? Yeah, well, so it's interesting. Whenever 01:48:30.319 --> 01:48:33.020 you're first to do anything or one of the first 01:48:33.020 --> 01:48:35.819 to do anything, the first people say, we've never 01:48:35.819 --> 01:48:37.220 done it this way, therefore it can't be true. 01:48:37.359 --> 01:48:40.680 So there's a whole wave of those people. Then 01:48:40.680 --> 01:48:43.119 there was no data out there to suggest that this 01:48:43.119 --> 01:48:44.859 works, except there was a lot of military data 01:48:44.859 --> 01:48:46.500 that we had to kind of bring forth to the civilian 01:48:46.500 --> 01:48:48.920 world and show people. That's what we used to 01:48:48.920 --> 01:48:52.720 prove the point at first. Now that we have a 01:48:52.720 --> 01:48:54.979 ton of civilian data, it all looks exactly the 01:48:54.979 --> 01:48:58.100 same. The next person to start tomorrow will 01:48:58.100 --> 01:49:01.079 not have a problem, at least exposing the fact 01:49:01.079 --> 01:49:04.140 that, hey, whole blood is the way to go. The 01:49:04.140 --> 01:49:08.539 problem with it is that it's expensive. EMS loses 01:49:08.539 --> 01:49:10.720 money everywhere. So now, hey, chief, I want 01:49:10.720 --> 01:49:13.119 to cost you another 50 grand a year on something 01:49:13.119 --> 01:49:15.460 that you don't have 50 grand for. There's all 01:49:15.460 --> 01:49:20.779 this paperwork, FDA requirements, QA, you name 01:49:20.779 --> 01:49:24.199 it, it doesn't end. And so people who are, if 01:49:24.199 --> 01:49:27.560 you're not a department that can flex its muscle 01:49:27.560 --> 01:49:30.960 and do all those things, then it's very difficult. 01:49:31.640 --> 01:49:34.340 So I think that the biggest barriers today are 01:49:34.340 --> 01:49:36.640 who's paying for it, if we can get it paid for. 01:49:37.149 --> 01:49:39.010 We're good. If we can swap it with the hospital 01:49:39.010 --> 01:49:41.470 so we don't waste it, that's another thing. And 01:49:41.470 --> 01:49:45.050 now more and more people can just give you the 01:49:45.050 --> 01:49:48.430 toolkit to say this is how you do it. So I think 01:49:48.430 --> 01:49:51.449 those are the three main things. Then you have 01:49:51.449 --> 01:49:54.810 the supply issue, which is a big one, not enough 01:49:54.810 --> 01:50:00.329 supply. And then, you know, I think that the 01:50:00.329 --> 01:50:03.869 naysayers are typically the people who the whole 01:50:03.869 --> 01:50:06.479 blood. on the ground units are taking away the 01:50:06.479 --> 01:50:08.319 business of the air units and that's kind of 01:50:08.319 --> 01:50:10.500 the most of the people i see coming out against 01:50:10.500 --> 01:50:12.920 whole blood are the people who were carrying 01:50:12.920 --> 01:50:15.739 whole blood dropping a helicopter and grabbing 01:50:15.739 --> 01:50:20.479 the patient charging them 15 000 and then um 01:50:20.479 --> 01:50:23.220 and then and now now we're saying oh we don't 01:50:23.220 --> 01:50:24.560 need you helicopter we're doing it ourselves 01:50:24.560 --> 01:50:29.439 and then finally the last question is um it should 01:50:29.439 --> 01:50:31.420 not be on every ambulance unit it should just 01:50:31.420 --> 01:50:34.979 be on a supervisor vehicle so like One city needs 01:50:34.979 --> 01:50:37.380 to just have one vehicle with the blood, and 01:50:37.380 --> 01:50:39.979 that vehicle should just be dispatched for the 01:50:39.979 --> 01:50:46.220 Delta Echo calls that would be a suspected hemorrhage, 01:50:46.279 --> 01:50:51.159 right? So it's coming. It's here. It's going 01:50:51.159 --> 01:50:53.560 to be here. It's not going away. Too bad, so 01:50:53.560 --> 01:50:55.920 sad for the people who don't think it's happening 01:50:55.920 --> 01:50:59.500 in real time. So Peter, for people listening. 01:50:59.979 --> 01:51:02.640 Where can they find Han Tevi and then where can 01:51:02.640 --> 01:51:04.640 they reach out to you online if there's any other 01:51:04.640 --> 01:51:08.340 places? Yeah, so I would say I'm on LinkedIn 01:51:08.340 --> 01:51:11.640 and you can connect with me there and we can 01:51:11.640 --> 01:51:13.539 text there back and forth. That's the best way. 01:51:13.619 --> 01:51:16.720 I'm there a lot. Han Tevi is just hantevi .com. 01:51:17.300 --> 01:51:21.260 And we also are on YouTube and I do a weekly 01:51:21.260 --> 01:51:24.859 webinar for EMS on the Florida NAMSP YouTube 01:51:24.859 --> 01:51:27.039 channel. But I would say start with LinkedIn. 01:51:27.399 --> 01:51:30.569 I post quite frequently. And I hope to engage 01:51:30.569 --> 01:51:33.630 with people there and would love to have people 01:51:33.630 --> 01:51:35.590 connect with me and give me their thoughts on 01:51:35.590 --> 01:51:38.189 today's podcast or anything that they think I'm 01:51:38.189 --> 01:51:40.010 missing. I always want to learn from others. 01:51:40.250 --> 01:51:42.029 Well, I want to thank you so much. I know you've 01:51:42.029 --> 01:51:44.250 got to go now, but thank you so much for coming 01:51:44.250 --> 01:51:47.029 on and not only talking about the technical side, 01:51:47.210 --> 01:51:49.130 but having that courageous vulnerability with 01:51:49.130 --> 01:51:52.130 some of the stories you've told as well. Thanks 01:51:52.130 --> 01:51:54.569 for giving me the space to do that. It's definitely 01:51:54.569 --> 01:51:58.409 therapeutic for me and I appreciate it. I appreciate 01:51:58.409 --> 01:52:00.689 you doing that. So it was great to see you. And 01:52:00.689 --> 01:52:02.109 hopefully it's not 10 years till we see each 01:52:02.109 --> 01:52:02.470 other again.