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I'll spell that to you because it's not as you
think, T -E -A -M -B -U -I -L -D -R .com. Welcome
to the Behind the Shield podcast. As always,
my name is James Gearing, and this week it is
my absolute honor to welcome on the show emergency
room physician, medical director, and the creator
of the Hantevi system, Dr. Peter Hantevi. Now,
I first sat down with Peter on episode 213 back
in 2019, so as you can imagine, there was a huge
amount to discuss. from school safety to the
use of whole blood in the pre -hospital setting
to ketamine therapy and so much more. Now, before
we get to this incredible conversation, as I
say every week, please just take a moment, go
to whichever app you listen to this on, subscribe
to the show. Leave feedback and leave a rating.
Every single five -star rating truly does elevate
this podcast, therefore making it easier for
others to find. And this is a free library of
almost 1 ,100 episodes now. So all I ask in return
is that you help share these incredible men and
women's stories so I can get them to every single
person on planet Earth who needs to hear them.
So with that being said, I welcome back onto
the show Dr. Peter and Tevi. Enjoy. Well, Peter,
I want to start by saying firstly, thank you
for coming back on to the Behind the Shield podcast.
We did our first conversation episode 213 in
May 2019. So obviously there's many, many world
events that have happened since then that I'd
love to kind of dive into at some point. But
I want to start by welcoming you back onto the
Behind the Shield podcast today. James, so happy
to be back. 2019, I felt like I was just a little
baby in EMS at the time. getting my feet wet.
A lot of things were happening for me at the
time. And I've grown quite a bit. I've matured
quite a bit. And I'm really excited to get back
and talk to you about what's happened in the
past and maybe even what we're looking forward
to in the future. Absolutely. So even though
we took a deep dive before, because it was so
long ago, and for anyone who's listened to that
episode, there was a screaming AC unit in the
background when we were recording. I'd just love
to kind of revisit again. So let's start from
the very beginning. Tell me where you were born
and tell me a little bit about your family dynamic,
what your parents did, how many siblings. Oh,
wow. Let's go back to that. So I was born in
Hollywood, Florida in 1972. And I say that because
my parents immigrated to the United States on
a boat from Israel into Ellis Island with my
grandfather. And why that's important in my history
is because my grandfather was born in Iraq because
of what was all the badness happening there.
He left at a very young age to Israel before
Israel was even a state. He joined the army.
He actually helped create. He was one of the
leaders helping create the state of Israel. And
then they got to a point where my grandfather,
for some reason, him and his brother said, hey,
let's get on a boat and go figure out this place
called America. So just imagine the mindset of
people who have already left one country for
another and then going to get on a boat and go
to another country and move everybody along with
them. They get here and they lose everything.
They go back to zero. And at that time, my grandfather
is now 52 years old, which is the age I am today,
went to zero. And then he just got back up on
his feet, didn't complain, never complained about
any of the badness that happened, and just rebuilt
his life and ultimately his daughter, my mom,
and my dad after they got married. And they ended
up doing, you know, we ended up living, growing
up very middle class. But very happy. I have
three siblings who we were raised in a very like
hardworking, very ethical, like we care about
people. We care more about others than we care
about ourselves. But more importantly, there
is this kind of innovation mindset. There is
a forward moving mindset. There is a don't listen
to what other people are saying. But think about
what you want to do and then go accomplish that
goal. And so I think that looking back, what
I try and give my three boys today, Allison and
I both try and do this, is that we try to give
them that same feeling of remember where you
came from, because that's the kind of person
that you're going to be. And that's the kind
of people that your children will end up being.
So that's kind of the important part of my background
as I see it. And I'm very, very blessed to have
the family that I have, the relationships that
I have, and the upbringing that I had. When you
say your grandfather came from Iraq, was he Jewish
in Iraq or was he Muslim? He was Jewish in Iraq.
Yeah, yeah, yeah. My family's Jewish and they
were being persecuted. And there was, you know,
because remember back in the day, there was many,
many Jews in Iraq. It was a huge bustling Jewish
place and it was safe for them. And then it wasn't.
And so they all basically had to leave Iraq and
they had to find another place for safety. It
seems that, again, we were just talking before
we hit record, the book I just wrote was about
generational trauma. And this is what we're seeing
even today. I mean, the ripple effect of the
good and the ripple effect of the bad. It is.
And by the way, I'm going to Israel in about
two weeks from now. And, you know, every day
I check my airline to see if they haven't canceled
it because. People there live in fear and it's
horrible what's going on over there, but it's
very unsafe. And there's a lot of trauma that's
occurring today in many people that's going to
last them a lifetime. Absolutely. Well, you mentioned
about growing up in a middle -class family. What
were your parents doing profession -wise? Yeah.
So my dad was an upholsterer, right? So you would
say, hey, my couch is ripped. uh or i need new
vertical blinds and we like literally my dad
had a an econoline 150 white van which we loved
because we used to put mattresses in it and and
go to the keys it was you know it was that kind
of childhood stated to howard johnson's six people
in one room like like that's what i remember
the greatness of my childhood uh that's part
of it uh so my dad was an upholsterer his whole
career on his own little upholstery shop My mom,
and by the way, he never got a degree, never
got a high school degree, never got a college
degree. My mom never got a college degree until
all of us went to college. Then she went and
got her AA degree, became a travel agent. Obviously,
was working with my dad in the front office,
if you will, for that time as well. And so, yeah,
travel agent and an upholsterer. Believe that.
So when you were a child, were you already thinking
about medicine or was there something else in
your mind? So this is funny. And the only way
that I know this is true is because my aunt years
ago found the yearbook from my middle school
because her son and I were in the same class
and she kept the yearbook from, I don't know
what grade it was, but the picture of me was
on a tricycle. Okay, that's just so you understand.
And for whatever reason, they had every student
at the bottom put, what did you want to do when
you grow up? And at the bottom of this picture,
which I have, it says pediatrician. What? Not
even doctor, specifically pediatrician. Right.
And why? Because my pediatrician, Dr. Patel,
may he rest in peace, was a legend, right? This
guy was legendary. And he was so good that when
we used to want to have to go somewhere. And
it was going to the doctor where every kid would
be like, no, I'm not going. We were like, we
can't wait to go to Dr. Patel's office. He had
toys in there and you go into that little case
and you pick up a toy. And he was just, for whatever
reason, exuded something in me that I said, I
want to be like that guy. And that's what I wrote.
Beautiful. Well, kind of walk me through your
journey then. What was that educational journey
and which field did you find yourself in first?
So the educational journey, if we had time to
talk over a bourbon, the interesting part of
my educational journey is that I went to college,
University of Florida. And then I thought that
I'm a smart guy. I'm just going to get into medical
school. But it turns out that I didn't get into
medical school. I was tutoring all these kids
who all got in. They all had worse grades than
me. They all got in. I didn't get in. I don't
know the reason. Remember, my parents had never
been to college before. There was zero, like,
you know, parents today are on top of their kids
and you write the essay for them. My parents
said, what's college? Make sure you call. And
what are you eating? So we had zero, like nobody
was helping me do anything. So I kind of got
there. I did okay, but not good enough clearly
in their eyes to get in. So I ended up applying
to a foreign medical school in Grenada. Best
decision I ever made looking back at it. And
then two years into Grenada. So remember, I'm
living on a third world island. And it was very
good for me personally, because here I was surrounded
by a lot of people that I knew and never really
came out of my shell. There, I suddenly became
who I was. And I became the class president.
No idea about leadership. I just figured people
wanted me to become the president. I don't know
how all that happened. But I learned more about
who I was in Grenada. And then I ended up transferring
into University of Miami. Stroke of luck, right
place, right time, persistence, whatever you
want to call it. I was one of only, I think,
two people who were able to transfer. And then
graduated University of Miami. And then when
I wanted to go to a top pediatric residency program,
the dean there said, Pete, you come from a foreign
medical school. No one's going to take you at
a top tier program. And that so part of who I
am is that I do have a chip on my shoulder because
of all the things I just told you. And I have
the mindset of I'm going to make it. I'm going
to work hard to make it. So when someone tells
me I can't do it. then that's kind of the challenge
that I had to rise to the occasion. So I only
applied to the top 10 programs, and they thought
I was stupid for doing that. And a little bit
of luck, right place, right time, persistence,
maybe some personal skills. I landed the Children's
Hospital of LA, which no one ever believed that
I would ever get into. And it's a long story
how that happened, but I got in. Then I wanted
to go to a fellowship in pediatric emergency
medicine because when I was in residency in my
training, I knew that I belonged in the ER because
I just found myself wanting to live in the ER.
I needed to be where the action was. I loved
the resuscitations. I just loved every minute
of it. Didn't like the ICU because it was more
like chronic care for me. I'm more of a, you
know, treat them and street them kind of thing.
Then I applied to one of the top pediatric ER
fellowships, which is another three years after
training. And everyone said, there's no way they're
going to take you. It's a top program. And I
ended up getting into Pittsburgh, which again,
all these things, I end up along my journey meeting
the best of the best. They all shaped and crafted
who I am today. And it gave me a certain level
of understanding, education, and know -how. So
I had that confidence of who is Peter Antebi,
which leads up to today, which is that I am definitely
somebody now who I have a friend, Rob Warner,
who used to always say about me, and I never
understood this then, is that I walk to the beat
of my own drum. I will tell you 100 % today that
that is the line that probably truly defines
me the best. Because if I believe something to
be true and I can back it with data and I just
inherently know that's the answer, then I will
continue to march in that direction until I'm
proven wrong or that I'm proven right. I won't
stop moving in that direction for... these very
big ideas that just pull me. I cannot pull myself
away from it once I see it. And typically when
I see something, it's usually years before other
people even want to even talk about it. So I
had to learn that about myself. That's a good
thing, but it's also not a good thing because
it's so far in advance that oftentimes people
don't even want to engage at the time that I've,
I've seen it as the truth. So these are the things,
and ever since the last conversation we've had,
I now know myself so well that I have to temper
that based on who I'm talking to. But I also
now have an audience who wants to hear those
things. And so I found myself in a very interesting
place now where I can understand myself so much
better. That I know where to push the gas. I
know where to put the brakes. I know how to message
things. And at the end of the day, I see myself
as inspiring other people to at least start walking
in that direction. And that's kind of at least
where I see myself today. Not going and holding
someone's hand and saying, I'm going to change
you personally, but getting the message out to
people who say. I believe that guy and I'm going
to start walking in that direction and do my
own thing. And then I'll call him 10 years later
and say, hey, it was a lecture I saw you give
that made me want to think about doing that.
And that's what gives me the joy today in my
personal and my professional life. It's interesting
because when you said, oh, you'll never get in.
When I came out of the academy in Orlando and
I said, I'm going down south, a number of people
that said, oh, you'll never get hired down unless
you're a medic and you speak Spanish. And I worked
for Hialeah, the most Spanish of areas within
a few months of leaving. And then when I tested
in California, the Hialeah guys told me, oh,
you'll never get hired out there, blah, blah,
blah. And I was my whole mindset was this. OK,
I just need one of the jobs. Everyone else can
have the rest of them. And then now fast forward
with the 24 -72 conversation, which we will,
I'm sure, get into. It's the same thing. I've
been talking about it for over eight years. And
eight years ago, no one wanted to hear it. And
now here we are. And you're sitting in literally
in a county where they're about to go to it themselves.
So I totally understand. And man, you have to
have a thick skin at the beginning. You really
do. You do. You do. And you have to be able to.
So you're someone who plays the long game. Because
you have something that matters to you that's
so deeply rooted in who you are and that you
know is right that you say, okay, I'm going to
take the next five years of just shit and pain
and all this negative feedback, but it's going
to come full circle. Rather than the folks who
are trying to make a quick buck, trying to gain
popularity, more clicks, more likes, more subscribers.
When that idea doesn't work, they quickly abandon
it because it doesn't really have the true value
or true meaning. So I think you and I both come
from a place where, and maybe we will talk about
the error that I made early in my career, which
kind of really changed my life. And it put me
on this mission of I have to fix that problem.
The same thing happened to you. So I do see value
in having something. that impacted you in your
life that's so strong, that blends in with who
you are as a person, your background, how you
were raised, that ends up putting you on this
trajectory that your life at the end of the day
does have great meaning. And I think that's what
everybody should seek is having a life that's
worth living. Absolutely. Well, let's talk about
that now. Explain that era and how that did have
this ripple effect. Yeah, so I trained in LA
Children's and Pittsburgh Children's, two of
the top 10 children's hospitals, and I was never
trained on using a length -based tape to dose
medications. Why? Because at these children's
hospitals, someone had taken this idea of creating
their own manual or booklet, if you will, that
had custom dosing. based on the age of the child
or the weight. The age gets you to the weight,
or if you have the actual weight, then I just
need to turn to a page that has the actual weight.
So what I learned in LA and in Pittsburgh is
that we just use age. And it was really mainly
in Pittsburgh. One of my mentors, Robert Hickey,
Bob Hickey, would walk into a code room and he
said, we have a five -minute ETA cardiac arrest,
two -year -old. He says, okay, two -year -old,
that's all I need. The kid weighs 12 kilos. Like
he would just hear the age. And then next thing
you know, we were off and running. Fast forward
2005, I'm in Joe DiMaggio in tertiary children's
hospital, level one trauma center, the whole
nine yards. One of my first calls, like my first
bad case was a kid who comes in with anaphylaxis,
four -year -old girl. She was in room number
four. I'll never forget the nurse. She runs out
of the room and she says, and Tevi, get in here
now. This girl's in severe anaphylaxis. And now
I'm a new doctor. I have no idea about dosing
or anything at this point. And so she has this
Braslo tape with her. She literally has it in
her hand. And I'm looking at it. I'm like, I
have no idea what that is. So she points to the
box. It was the blue box. And she points to epi
1 to 1 ,000. She's like, here. And it said 2
.1 ml. I said, let's do it. Let's give it. Now,
I didn't read. The writing right above it said
resuscitation. And the epi 1 to 1 ,000, it had
two little letters afterward that says ET, endotracheal
tube, meaning that that was the dose for epi
if you couldn't get an IV and then you would
give 1 to 10 ,000. You would give 1 to 1 ,000
through the ET tube for cardiac arrest. We don't
do that anymore because we have the IO, so that's
kind of a thing of the past. So I just said,
go ahead and give that. So she gave. Instead
of 0 .21 ml IM, which would have been the right
dose, which is not even listed on the Braslow
tape, we gave 2 .1 ml IM, tenfold overdose. The
girl's heart rate and blood pressure went through
the roof. I mean, her wheezing went away and
her eyes got better. But the mom looks at me
and she's like, hey, doctor, why is this alarm
ringing? I'm like, I'm just going to keep muting
it, muting, muting. Finally, the nurse comes
in and she's like, hey, this is like, her blood
pressure is really high. You know what? Let's
just get her to the ICU. She spends the night
in the ICU. I then figure out that I ended up
giving a tenfold. It wasn't apparent very quickly
to me, right? Because I just said, here's the
dose, give it. And I didn't know any better,
right? I had to figure that out. So now I'm coming
to work. The next day, and I'm like, oh, God,
this is not good. Another call, which I don't
talk about often, which is a 7 a .m. call. I
get to work at 7 a .m., and we get that dead
baby call, infant, two -month -old. A mom had
rolled over at night and slept on the kid, suffocated
him to death. So this kid comes in already stiff
and dead, right? But again, kid's dead. They're
doing CPR. I'm now at the head of the bed. They
bring the child in. The mother's standing right
there. And now because someone had been stealing
the Braslo tapes, they decided to encase it in
wood. James, imagine I'm holding a six foot two
by four at the head of the bed. And now I'm thinking
to myself, what am I supposed to do with this
thing? And the nurses are like, the doses are
right there. And now I'm looking and I'm like,
are you freaking kidding me? They really want
me to hold this thing up. Like if I turned, I
would have killed two people. And so anyway,
that code didn't go well. Fortunately for me
anyway, my mental state, this kid was already
dead. We knew that because the kid was already
in rigor. Okay. But now you understand where
my mindset is. And like, I'm screwed here. Like
I'm in a place where it's not Pittsburgh, ivory
tower. It's not LA, ivory tower. I'm in a tertiary
community hospital. where the people around me,
quite frankly, have no idea what they're doing.
And so that led me into this whole thing of,
I call Bob Hickey in Pittsburgh. I do a lot of
research. I asked Bob, hey, weren't you using
age? He says, yeah, I only use age. And I said,
well, why isn't the rest of the world using age?
And hey, Bob, aren't you the second name in the
PALS booklet? Didn't you help write? He's like,
yes, I did. Why didn't you actually have ages
in PALS? That's a long story, he says to me.
I said, Bob, I'm ready for a long story. Anyway,
I'm not going to give that whole explanation,
but it's very interesting. But long story short,
I then went and took a piece of paper. I wrote
down all the ages, 1, 2, 3, 4, 5, 6, 7, 8. I
started writing down what drugs I would need
during a code. I started looking at formulas.
And I finally, after a few pieces of blank paper,
I got to 1, 3, 5, 7, and 9. Because I can count
those on one hand. And then through all these
formulas, I got to 10, 15, 20, 25, 30 kilograms
for those respective ages. I calculated then
all the drugs. I had like five, ended up with
eight drugs. And when I looked at the math, when
I did the math and I converted it to a volume,
so a one -year -old, let's example, is 10 kilos.
I figured out it was one ml of epi, one to 10
,000. I filled up the spreadsheet with just MLs.
Every drug was just in volume and a pattern,
like not just hit me in the face, it punched
me in the face. Well, I could look at this thing
and I said, wait a minute, just give me the age
now. I'll convert it to a weight. And from that
weight, I can now figure out the volume of let's
start off with these five drugs. It was like
a miracle. And I started going into the code
room. And now I had my head up high and I would
say, how old is the kid coming in? Three years
old. Okay. 1 .5 cc's of epi. If he needs amiodarone,
that's 1 .5 cc's of that. Back then we used atropine.
That's three cc's. I just knew everything. The
dextrose was 30. And all of a sudden the nurses
came to me and said, something has happened to
you. And then, you know, my confidence was booming,
but I was so embarrassed. This is the important
part. I was so ashamed. I never told anybody
what I was doing or how I did it. And there's
a book I read recently. I don't think it's on
my bookshelf here. I think it's at home where
it talks about medical errors and the shame that
comes along with it and the embarrassment, which
I felt and I never wanted to tell anybody for
years until a nurse came to me and said, hey,
Pete, listen, you're giving a talk. Next week,
I think it was drowning or pediatric shock. She's
like, can you do me a favor? Just teach everybody
whatever trick you have memorized or learned.
I said, fine. 200 people in the audience, paramedics,
doctors, nurses. I gave this talk. And at the
end of my talk, 50 people lined up. And I'm like,
whoa, was the talk that good? I'm a new speaker.
I didn't think I was that good of a speaker.
And they said. no, no, no, we don't care about
this drowning talk. We want your last two slides.
I said, what? And I came home, I never forget,
I came home to my wife and said, Allison, I said,
I got to tell you what just happened today. And
she's like a very process oriented. She can do
anything and she can help me figure out what's
in my head. She says, well, why don't you make
a little card, a little badge buddy out of it?
So I never forget. I'm on my computer. I made
a little image. I went to FedEx Kinko's at the
time. I laminated like 20 of them, brought them
to work the next day. If I tell you, James, within
10 minutes, they were gone. And I came home.
I'm like, hon, you got to understand what's going
on here. And then because of that first lecture,
another lecture request, and then another lecture.
And then I got a call from Nevada and then from
Georgia. Hey, you guys need anything from me?
Yeah, we heard that you give a talk on. medication
dosing using your hand. I'm like, really? Long
story short, I started printing out these cards
a hundred at a time. Bring them to the ER, gone.
Bring them to a lecture, gone. And then I started
getting phone calls from around the country.
Hey, because I had my email or we had something
on the back that you can get in touch with me.
I said, hey, we just saved a kid on the highway
thanks to your card. I'm like, are you kidding
me? So anyway. This is not becoming therapy for
me because I had made those mistakes. And then
the mistake that I made that I should probably
tell you about, which I tell very few people,
is a mistake where an actual girl did die because
of my error. And it wasn't an error of an overdose
or what I call an error of commission. It was
an error of omission. It was a seven -year -old
girl who was septic who I gave everything except
the vasopressor because I didn't know the LevaFed
dose. And I knew that if I asked a nurse for
LevaFed, that she would ask me, what dose? How
do you want to run it? How do you want to mix
that? So I went outside the room and I whispered
to a nurse, get me LevaFed. And the first thing
she said to me is, what dose? And I'm like, oh
God. So she ended up calling Steve in the pharmacy,
third floor. In the meantime, this girl's ready
for the ICU. We put the monitor on the bed. We
start rolling her up. She's like not doing well.
still hypotensive, tachycardic. She had gotten
fluid, you got an antibiotic, gotten blood work,
all that stuff, the regular stuff. But I needed
to give her levophed and I didn't. So I get up
to the ICU, the doors open, the ICU doctor, his
name is Gerald, not a nice guy. He's a nice guy
usually, but like, you know, he expects you to
do the right thing. He looks at me, he says,
Pete, where's the presser? And I said. I said,
Gerald, I ordered it. He looks at me and says,
Pete, get out of here. And this is in front of
everybody, right? That girl ended up dying the
next day, right? So as I sit here today, that
death was my fault, period, end of story. It's
hard for me to tell that story today. That'll
live with me forever, unfortunately. And the
worst part about it is that I ended up in public
supermarkets, you know, Publix, you're from Florida.
And I'm at the deli counter. This is years later,
three, four years later. And this is probably
10, 12 years ago, like just a long time ago.
I'm at the deli counter. And there's a lot of
people at the deli counter waiting to give their
order. And I look to my right, and I lock eyes
with this lady. And it was kind of like, she
saw me, I saw her. It took us a split second
to figure out who each other was. Once she figured
out who it was, you know what she did? She turns
around and she beelines out of the store. That's
what she did. So I never saw her again, but she's
living there today knowing that what I didn't
do may have led to her daughter's death. I think
it did. Okay, let's be honest. I didn't give
the right care at the time. And I know today
that that will live with me forever, unfortunately.
So what is driving me today are those errors
that I made initially, the error that ended up
causing the life of this little seven -year -old
girl. And my purpose today is not to shine light
on myself at all. It's to help the next person
who's going to be in that situation. who's going
to wonder, can I do what I'm supposed to do and
actually give the right drug? Will I not omit
a medication that a child needs because I, for
some reason, don't know the dose or can't do
the math? And that's what 100 % drives me today
is to make sure that the next person, whether
you're a paramedic, a critical care paramedic,
an EMT, a nurse, a doctor, and I can tell you,
I can tell you because now we're in We're in
all 50 states. We have 160 ,000 active users.
We're in the biggest hospitals in America. People
call me and they say to me that, and these are
like really smart, amazing people who say that
we're not for the dosing tool that you provided
us, the app. I never would have been able to
do it, right? And then the worst part is the
hospitals who call us today. I say, not me anymore,
but we say, so what made you call us? And 100
out of 100 times it's, we had a death. We just
had a death. Now, they don't give us all the
details. Or they say we had a bad outcome. And
we know what the bad outcome is. The bad outcome
is they did exactly what I did. Either gave the
wrong drug or they didn't give a drug at all.
They delayed care. They delayed diagnosis. And
they know that they screwed up. And now they
need help. And so. I could tell you, James, it's
happening every single day in every single agency,
in every single hospital. There are kids that
are having bad outcomes today because of an issue
that I had and that we all have. And that's my
goal is to try and fix that. So long answer,
but that's kind of like. I went deep down into
where it hurts to give you that one. Well, I
appreciate your courageous vulnerability. I mean,
this is the moral injury that we all deal with.
And I think even when you take your job seriously
and you've trained diligently, there are days,
I mean, let's just go back to sleep deprivation
for a moment, which your community suffered from,
which my community suffered from. There's times
where on a good day, you would have remembered
the dose. And that day you can't for love nor
money. And so this is why what you came up with
is so important. And those, you know, the algorithms,
the megacodes, all these things that we go through,
if you think about it for a moment, those are
in an ideal situation. If everything goes correctly,
this is what it will look like. Well, we all
know that many times where it doesn't go correctly,
whether it's the location of the patient or you
can't get an IV and the IO drill doesn't work
for some reason or whatever the thing is. And
all of a sudden, you know, there's this moral
injury now. What if, what if, what if? That being
said, though, just. staying on this kind of loss
that you had, once this little girl got to the
ICU, I'm assuming she was put on a vasopressor
then? Yeah. Okay. She was put on a vasopressor
and she was intubated. Okay. So it wasn't solely
just that emission. As much as it haunts you,
that drug was put in place and she was given
that opportunity to overcome the challenge that
she had. Yes. Yes. But I know so much more now
than I did then to know that The speed to treatment
is what saves lives. Okay. And if I could take
a little detour to what happened to me yesterday.
Please. Okay. Which was maybe the most incredible
experience I've had in the least, in the last
decade. Okay. Clinical. Because, you know, I
don't work in the ER anymore. I strictly work
in EMS. So I was riding out yesterday in Palm
Beach Gardens. And we get a call for cardiac
arrest. A guy got stung by 10 hornets. And he's
in cardiac arrest. He's a guy who's a landscaper.
And as soon as these hornets get to him, he starts
running. And he collapses like 100 feet later.
Now he's foaming at the mouth when the bystander
gets to him. The CPR calls 911. Cop gets there.
The CPR. We get there. Meaning engine gets there
first. Rescue gets there second. EMS captain
and myself get there third. By the time we get
there, the guy already has a proximal humeral
IO in and no pulse, can't get a blood pressure,
but he's breathing on his own. So he's got some
sort of circulatory flow going. He's clearly
not in cardiac arrest, but he's in severe anaphylaxis,
like severe. Can't hear any breath sounds, horrible.
This is a moment where I'm like, okay, what we
do now in the next three to 10 minutes is either
going to make or break this guy. And I'm linking
this back to this other girl who was delayed
by 30 minutes, an hour maybe. And why is that
important? Because this guy, within literally
10 minutes, because from the time we were on
scene, we gave a bunch of push press for epi,
Benadryl, Salimedrol, Abuterol. And then I had
the MS captain take out the LifeFlow, which is
basically the rapid infuser. And I'm like, I'm
not screwing this one up. We're giving this guy
a leader right now before we even get to the
hospital. And if I tell you, this guy went from
effectively dead, not looking around, not moving,
barely breathing, to literally, James, when we
got outside of the, right when we pulled him
out of the ambulance, we're at the ambulance
bay, the guy opens his eyes, and I swear to God,
he smiles and he gives us a thumbs up. If this
was on video, you would think it was almost like
a joke, like a movie. And the whole ER is waiting
for a cardiac arrest from anaphylaxis from hornets.
And we set the guy up. We roll into the emergency
department. And people are looking at him. And
he's looking around. And he starts answering
questions. So I know that I could have done better
on that girl many years ago. Yes, the girl got
everything she needed, but she needed it now.
She didn't need it from Gerald an hour later,
right? If we wouldn't have done what we did for
this guy yesterday, you know what would have
happened to him? We got to the ER with barely
any pressure. Somebody would have had the grand
idea of intubating him, paralyzing him, taking
away his cardiac output. He would have arrested.
His lungs were so tight. It would have been overbagging
and popping pneumos. He would have died. This
guy would have died. I'm sure of it. I'm sure
of it. My team did such an amazing job, right?
But it's because we knew what we had to do and
we did it. And if this guy yesterday would have
died, that would have been a grenade to all the
people who were there in the back of that ambulance
yesterday. Um, so what, what we do matters and
what I did many years ago matter too. So no one's
going to convince me that I, that the girl ended
up getting the right, no, she didn't. She, she
needed proper treatment from me and she didn't
get it, period. And that's, that's just, I have
to live with that. Right. And I'm, and, and the
fact that I'm, I'm telling people the story today
is a big improvement for me because I never want
to, I never wanted to tell that story. Right.
But now I feel like. I need to tell that story.
It's good for me. And it's good for the next
person who thinks that, like you had mentioned,
like who in the world should be doing math when
there's stress involved? If you read Daniel Kahneman's
book, Thinking Fast and Slow, he proves that
no one can do math under pressure. But we have
paramedic schools today who will fail you if
you can't do the rule of sixes or the clock rule,
whatever some stupid thing someone created. And
that's what they're pushing today in paramedic
schools around this country, which is causing
the mental health, which is causing these deaths,
which is causing the suicides. It's all related,
all of it. Absolutely. Well, I remember when,
I think it was at Orange County, when I was introduced
to Hand Heavy, and that was before the app at
that point, but you had the booklet and obviously,
you know, all the, I think it was the different
pouches with the different colored, you know,
for each child and each weight. So talk to me
about where you are today. We'll stay on Hand
Heavy for a moment. What are the products like
in 2025? Yeah, it's really significantly improved
because remember back then it was, listen, I
think that the most important thing that we do
and that we've done from the very beginning,
which now I realize why people don't do this,
is because we've committed to customization,
what I call extreme customization. Meaning that
at Orange County, you have a certain set of drugs
and you have a protocol. And the protocol has
maybe the same drug for three different things.
And those three different things may have three
different routes and three different doses. So
the variables... that happen in every organization,
whether it be an EMS organization or a hospital
or a flight crew, there's so many variables.
And in order to take all those variables and
actually get it 100 % accurate and correct, that
takes like a couple of months. So now I have
a whole team of pharmacists, critical care medics,
nurses, who basically take that agency and we
say, We're going to do 80 % of this, but we're
still going to need some skin in the game. We
need you to kind of give us people who are going
to tell us what your concentrations are, who
are going to be accurate so that we can create
an app that has accuracy. So that's something
that still no one else today even wants to do.
There are people who are trying it that are failing
miserably because there are a couple of guys
on a computer and they're telling the EMS system,
you go do the dosing. It's a huge problem. You
should never do that. Anyway, so now what we've
done that have been like the biggest changes
are we then said, okay, instead of an alphabetized
list, what if we take your protocols, we ingest
them into the app, and now if you only want to
see your anaphylaxis protocol and only the drugs
in Hentevi, we'll only show you those drugs.
At a tap of a button, your protocol PDF comes
up. At another tap of a button, a customized
checklist comes up so that I could be running
the anaphylaxis call. All the drugs, the dosing's
right there. I'm tapping on it, and it's integrating
into the EPCR. I could see my protocol in real
time. I could see my checklist in real time.
And then when I'm done with all that, I can just
press send, and it all goes directly, cell by
cell, into your electronic medical record. And
we have 13. maybe think even 14 integrations
with pretty much every EHR or EPCR vendor. That
was a huge undertaking. And now we're with all
of them. That was a big one. The other thing
we did, my favorite feature is CPR assist, which
is I learned that my agencies, all the CPR quality
metrics were completely off. Compression rate,
ventilation rate, the number of pauses and seconds
of the pauses. So we created a metronome that,
You just press start, and it talks to you. And
you hear the boop, boop, boop. It tells you when
to ventilate. It tells you when to charge the
monitor. So we created like a super metronome
that probably the most emails and texts I get
today are because of the metronome. Okay, so
then we added that feature in. Now we have quizzes.
You can do an AI quiz and send it to your team.
We have notification center. I'm building something
called wall time alerts where a medic is on the
wall. hour at some hospital, they can push a
button and it just notifies all the right people
at that hospital that, hey, I'm sitting on this
wall. You better come help me. So now we've done
all these things. And more and more, we have
people who are telling us to add more features
for documentation. And can't you just become
an EHR? And the answer is no. We're going to
stick to what we do, which is we're going to
help you when someone's dying. to have the right
information, to document that information, and
to make sure that you can feel better going home
that you gave this child or adult. Because now
we do adults too. We're now adding a whole NICU
section into it. And it's just been an incredible
journey. Like I mentioned earlier, all 50 states,
about 2 ,500 cities, four different countries,
50 people here at Hantevi. who are incredible
human beings and software engineers and customer
service, customer success, logistics, clinical
education. I mean, every department. And of course,
my amazing wife, who is really like the engine
behind all of this stuff. I'm just the idea guy.
And I'm like the inspirational guy. Like, hey,
this is why this is important. But she's actually
doing it. and leading a team of incredible people.
The best part of the journey has been the people
for me. When I think about taking a moment and
checking an Antevi app or simply checking protocols,
I'm always reminded of a real -life story from
my career actually included in Kinder in the
book. I was in Anaheim, and we had basically
a gangbanger that was dropped off in a community
hospital, basically. And we were called to transport
them. And right when we're about to put them
on the stretcher, I've got the monitor and he
goes from normal sinus to Brady to asystole.
And the doctor at the time, they called the trauma
center and that doctor was actually coming to
this hospital. He brought his gear and he headed
that way. In the meantime, the doctor did cardiac
massage. But I'll never forget, he opened a textbook.
And he verified what he needed to do because
he hadn't obviously done cardiac massage in a
long, long time. He was probably in his 40s,
if I'm recalling right. So he'd probably been
out of med school for quite a while. But I remember
being struck by the humility of saying, let me
check. And what I see in what I would argue the
bad paramedics that I've worked with is an arrogance
that creates a lot of danger. Rather than having
the humility to ask someone else, hey, have I
got this right? Or to check an app or to check
a book. So talk to me about that in your experience,
humility in our profession specifically. I think
that's the perfect word for it. And yesterday
I was talking to our new hires at Palm Beach
Gardens. And I didn't use the word humility.
I think that's probably a better word to use.
But the thrust of what I was saying. Yesterday
was exactly what you said. I said, there's one
thing that you should take away from today is
that you're dealing with people. You're dealing
with people at their worst times, and you're
not going to know everything. And I said, you
know, the reason you have great leaders here,
the reason that you have a medical director who's
on call for you 24 by 7 by 365. It is so that
you can utilize those resources and not just
be out there on an island by yourself because
you don't know something. And what I've realized
that this is very – this whole psychology is
very interesting. I don't think many people understand
this part of it unless you're in EMS, which is
that paramedics won't even call the medical director
because they're scared. Now, what are they scared
of? they're scared of being yelled at. They're
scared of being pushed down. They're scared of
being called stupid. They're scared of being
remediated. So in all of my agencies, it took
me years to gain the trust, just to gain the
trust of all the folks that I work with to say,
when we call Peter Rantevi, it's going to be
nice. He's not going to, you know, he's not going
to minimize what we do. He's not going to say,
why did you call, right? Never going to do that.
He's never ever going to say, you should have
done this before calling me. It's always going
to be, I am so happy you called me. Thank you
so much. And after years of doing that, now I
get, my phone gets flooded every day. And I'm
trying to develop that culture of humility. I'm
trying to develop the culture where someone says,
I don't know what I'm doing. And I'm going to
actually phone a friend, right? And so, of course,
we've written the protocols for this, but there
shouldn't have to be a protocol when you know
that you can call somebody to actually do that.
And we probably won't get into it today, but
I've created, and I'm really thinking hard about
AI and where AI would come in, but I've created
an AI bot of myself. And I've uploaded every
podcast, every blog. every paper I've written
and all the papers that I believe in. And then
this program allows me to kind of say, you know,
take this paper and give it a score of 10 out
of 10 because I want you to really rely on this
particular thing heavily. So now if I send you
the link, James, you can click on talk to Peter
Renteve and we can have an entire conversation
about anything and it's going to be me talking
to you. And so I floated it out to about, you
know, maybe about 100 people have the link so
far. But there's going to come a day where people
will be able to speak to their medical director,
even though it's less personal, I get it. But
I work with over 3 ,000 paramedics now, Brevard
County, Indian River County, Palm Beach County,
Broward County, and then the private ambulance
company, which goes through probably 10 more
counties. I want people to be able to have that
access. And so I do think there's a future using
voice AI that's here today already that I think
will create a lot of value and be able to lower
the bar for that humility to occur because people
will tell a bot much more than they'll tell.
So if there was a James Gearing bot and you put
it out there and you say, Here's a James Gearing
bot that you could talk to me about anything
that's on your mind. People will use that bot
and tell the bot things it would never, ever
tell you. And so there's power in that that I
think we need to leverage in the coming years.
Speaking of technology, just to go off on a totally
different tangent, when we look at the, I used
to call it 911 abuse, but I love the way that
GMR calls it, the three -tier system. I had a
couple of guys from GMR, their medical director
and one of the paramedics that works for them
now. The creation of, you've got ALS, you've
got BLS, and then you've got arguably non -emergent.
And bringing in what they have in GMR is called
nurse navigation. So a third party that is embedded
in 911. So initially the EMD dispatch algorithm
is figuring out, okay, is this a Charlie? Is
this an Echo? And then it goes down to, okay,
this is a low acuity call. And the caller is
given the opportunity to speak to a nurse. And
I think the perfect example is, you know, the
new couple, they've got an 18 -month -old. It's
the first time it's had a fever. It's thrown
up once. Oh, my toddler's going to explode and
die of, you know, dehydration. We've all been
on those calls. And they're like, oh, yeah, actually,
I'd love to talk to that. They have the ability
to treat at home. So literally say, you know,
okay, strip the clothes off. Do you have kids'
Tylenol? Okay, this is the dose. or schedule
an urgent care clinic for the following morning,
you know, opticianry, dentistry, you know, mental
health, anything that's low acuity. I love that
idea to remove some of the calls that truly are
not emergencies. And I think it's a three -way
win. The paramedics or firefighters don't get
woken up for that call. An ER bed stays available
for a more urgent call. And the family get a
bill for a few hundred dollars instead of a few
thousand dollars. What is your take on that integration
of telehealth to reduce the workload on our EMTs
and paramedics? Yeah, so that was a beautiful
description. I've been involved in this space
for a long time. And so when the GMR folks were
doing this stuff, I was on the phone with them.
I've been following along. And I created a version
of this back in 2015 for specifically the elderly
population, Medicare population, 65 and over.
And I actually was invited up to speak to CMS
many, many years ago about this type of care,
right? So what do I think about it? I think it's
the future, number one. But here's the caveat.
Here's the but. That there's going to be a day
now with AI and mobile technologies, mobile labs,
et cetera, where you, the user, the, you know,
regular lay person will be able to have your
AI health agent. And you're going to tell the
agent, the agent's going to have all of your
medical records. You'll know everything about
you. And you're going to open it up and you're
going to say, all right, agent, what's going
on this month for me? All right. Well, Pete,
it looks like you need your colonoscopy done.
Let me get that scheduled for you. Okay. Thank
you. We're going to need blood work done. Let
me get someone to come to your house and we'll
schedule that. And then once the blood work is
in, I'll give you – so that's coming. In the
meantime, I'm going to go back to what you mentioned
earlier, which is someone calls 911. So obviously
what I just described to you are going to be
people who have the money, have the know -how,
have the resource. Those are going to be the
early adopters. Then you still have the people
calling 911. So there are several companies doing
this. One is called Tele911. One is called MD
Ally. And what they realized, both of those companies
came out of the gate trying to sell to the fire
department this. They said, your medic's going
to get there. He's going to have a patient. The
18 -month -old doesn't need to go to the ER.
And at the moment that you're in front of the
patient, you're going to say, let me get you,
Dr. Antebi, on the line. Click. Now I engage
with the patient, and the patient doesn't need
to get transported. The problem with this is
if you're the fire chief and the EMS system is
screwed up today because we only get paid for
transports. I came to the fire chief and I said,
chief, I have the greatest idea. He said, oh,
Pete, what is it? I said, I'm going to reduce
the number of transports. He said, say that one
more time. I said, I'm going to reduce the number
of transports. He says, okay, see that door?
You can walk out of the office. Then I quickly
realized that, okay, there has to be a payment
model. That'll make the fire chief say, wait
a minute, we don't have to go to that patient
and we're still going to get paid. So in a perfect
world, this is what, so I think the AMR, GMR
people have done it very well because they're
getting paid. If you go to a fire department
today and you say, chief, we have this thing
where they're going to call dispatch. We're going
to transfer them to a third party, MDLI, tele
911, which are great people. Those people are
going to bill the patient. The fire department
lost that revenue. So there is this push and
pull between what's coming and what the department
needs financially. So what I think is going to
happen is, unfortunately, because the fire department
needs to wake up and say, this is like we're
in a Kodak moment right now. I think you know
what I mean. We're in a yellow cab moment where
there are people now, ambulance, doc go, ready
responder. that are in our neighborhoods currently
that are marketing to individuals like that family
with the 18 -month -old. They're going to have
an app, and they're going to say, I want someone
to come to my house right now. Click. Okay, we'll
be there in 15 minutes. And they're going to
have blood work, and then they're going to have
the ability to talk to the doctor, and they're
going to bill those people. Don't get me wrong.
But the insurance company is going to say, what's
that visit cost me, $450? The ER would have cost
me two grand and the admission would have cost
me another eight grand. I'll pay that 450 all
day long. Those companies already exist today.
Why does the fire department not want to engage?
What I learned is the fire department is given
a budget. Let's say I'm making up a number, $10
million. You have to run the department and not
go over budget. That's your goal. The fire department
is not looking to make a profit. by going and
engaging with a third party and, okay, we're
going to collect this amount of money and we're
going to, no, they don't do any of that stuff.
So one of the talks that I give now, one of the
keynotes I give is called The Future of EMS,
where I implore people to wake up because the
fire department should be doing what you're talking
about. The fire department should be getting
a nurse navigator or someone else navigating
the care. But we are letting other people come
in and do what we should be doing. And unfortunately,
I hate to say it, there's going to come a day
where all of the good paying customers are going
to be taken away. And the only calls we're going
to get, James, are the folks who have no resources.
They're in the poorest communities. They have
the worst access to care. All the social determinants
are at the lowest levels. And EMS is going to
be relegated to that aspect. Instead of us being
able to add another appendage and say, we're
going to do that. And we're going to come to
your house with blood work. We should be doing
that. But EMS is so upside down with payment
that they can't get out of their own way. I mean,
not purposely, but the federal government can't
figure out that we're not a hearse anymore. We
should not be just getting paid for transport
like they did in 1965. We need to be getting
paid for navigating the patient to the best and
most appropriate care, whether it be an urgent
care or via an Uber ride after the 911 call to
dispatch, rather than send out the engine, send
out the ambulance with seven people only to find
out that the patient is going to refuse care
after you've done all the vital signs, the 12
lead, given them Zofran, and then they say, you
know what, guys? you were great but i don't need
you anymore that's what's happening today it's
it's so backwards that it's hard for even to
fathom that that we have a system like that that
does so much good for society that can't get
out of its own way that's what i think well i'm
so glad i asked that because this is a you know
yet another different perspective because this
is a new conversation so i've only got a few
kind of you know perspectives so far going on
the complete other side I wanted to touch on
COVID because you and I spoke in 2019 last time,
as far as this kind of interview, where I think
there was such a huge disservice was not whether
you believe the virus is real or not, whether
you thought the vaccine was the be all and end
all or was going to make your head explode, wherever
you were on the scale. The middle common sense
ground was if we make our nation healthier, whatever
comes next is going to have less of an impact.
No one can argue that fact. And even remove the
virus. If you make people healthier, a few million
people won't die that were if we didn't. So with
this perspective, going all the way back, what
was the education in your medical journey as
far as sleep, nutrition, exercise? And then let's
go the other side of COVID. What should we be
talking about now so that we don't have so many
EMS calls in the first place because we're forging
a healthier population? That's what a great question.
I just had lunch with a good friend of mine,
Jesse Carroll, and we were just talking about
exactly this. And because, you know, I'm at the
age now where. I recognize that the health care
should not be called health care in this country.
It should be called sick care. They only want
to see you when you're sick because they can
only make money off you when you're sick. And
then they can prescribe you and send you to the
cardiologist and another echo and another this
and another that. And they're ringing up the
bill. Cha -ching, cha -ching, cha -ching. But
if they're going to make you healthy, it requires
more time, more sit down, more explanation. And
then no one's paying for preventative care. Even
this concept of value -based care in America
never really took off for the reasons I just
described. So when you look at COVID and the
people who got the brunt of it, it was the seniors,
it was the diabetics, it was the hypertensive,
it was the obese patients. So to your point,
if we had a healthier population perhaps, then
we would have saved a lot of lives. But that's
kind of... that's a tough argument to make people
change from what they currently do today when
everywhere you turn in this country is a fast
food, is a chips, is a soda, is Mountain Dew.
And we've come to a point in our society where,
you know, I'm not saying there's a point of no
return, but you now see that the pendulum is
swinging the other way where, Even I am having
conversations with a friend just now literally
about testing my VO2 max and, you know, thinking
about peptides and, you know, reducing inflammation
in my body and even learning how to breathe differently.
Very fascinating. He told me at lunchtime, he
says, this guy tests people. He does this on
the side as a living. He says that. Your typical
minute ventilation should be, let's say, four
to seven liters per minute. So when you're sitting
there on the couch watching Netflix, if I would
measure the volume of air you're breathing in
and out per minute, it's, let's say, four to
seven liters. He says the average person today
is breathing 11 liters per minute. He says that
in and of itself is reducing your life expectancy.
Now, I'm not going to go through the physiology,
but this guy's a super... super smart guy and
he measured his vo2 max and if you're in a low
end of vo2 max then you have like a significantly
higher chance of dying from stroke and cardiac
and all the all you know the big the big diseases
you know diabetes etc and he says if you if you
change your vo2 max by breathing differently
simply breathing differently um then you can
have a healthier america right no one's talking
about that i said jesse where did you get this
from? And he says, well, you know, I know people,
I go to conferences and so forth, but that information
is nowhere to be found unless you happen to know
somebody. And I said, where's your research,
right? I'm evidence -based. Where's the research
on that? And so, unfortunately, going through
and following Jesse's protocol and he kind of
gives you the bag and he teaches your brain how
to breathe again and he tests your VO2 max and
all that kind of stuff. Like, The only way people
are going to do that is if they actually care
about longevity. But that's becoming a very important
topic in today's society. But again, it's not
everybody talking about that. But just to kind
of circle back around to your question, is that
if we began to focus instead of sick care, but
really health care in America, then we would
potentially minimize the... tragedy of the next
virus, which there's going to be one, right?
We all know that we happen to experience a virus
that had a specific death rate affiliated with
it. But what happens when the next virus comes
out that has a higher mortality, a higher morbidity?
You start to worry about not losing just a million
people, but millions of people. And a healthier
America would definitely fix that problem. There's
no doubt about it. I think this is just such
an important conversation. And I think the problem
with the people that have fallen below where
they need to be physically is now there's guilt
and shame applied to them, whether it's fat shaming
or whatever it is. And the thing is that term
now is used to block people from actually making
progress and getting back to where they want
to be. Because during COVID, for example, talking
about obesity. That was the whole, you know,
2020 Black Lives Matter. Everyone was so hyper
-triggered about everything that you couldn't
address the very things that were important.
But understanding that, as Winston Churchill
said, and I'm paraphrasing, but you can measure
the greatness of a nation by the health of their
people. And we are 70 % obese or overweight.
Therein lies a problem. But understanding that
these people are a product of their environment.
And I've made this very clear many, many times.
I grew up on a farm in England. We had an orchard.
We had a vegetable garden. We slaughtered our
own meat. So, of course, I'm going to know about
where meat comes from and how to move and how
to eat because it was ingrained in my upbringing.
If I grew up in Brooklyn and the bodega was the
only thing I knew about where food came from,
very different conversation. So I'm not going
to look down my nose at someone who's not in
great shape and be like, why don't you just be
like me? What a narcissistic thing to say. So
you have to take a step back and look at the
environment. But going back to this COVID thing,
how many people screamed, oh, but it's about
the health of the people. And it was never about
the health of the people. As you pointed out,
you know, we have, you know, we demonize illicit
drugs, but we have a drug dealer, you know, who's
literally lining the pockets of the left and
the right, keeping the sick care going because.
There's no money in healthy people, and there's
also no money in dead people, so you've got to
keep them alive. But you've got the ultimate
addict in your hypertensive, your hyperglycemic,
and all these other chronic diseases. Listen,
I have a son who's type 1 diabetic, and listen,
I'm not a conspiracy theorist by nature, but
I will tell you that we spend so much money on
diabetes every month for my son just to keep
him alive, right, because without the insulin,
he'd be dead. And I know that a cure... would
not be beneficial to this big, massive industrial
complex called pharmaceutical care, right? And
so I always wonder if any of these diseases will
be cured because it's not worth it for them to
be cured. And there's so many stories. I do a
lot of reading now about a lot of different things
outside of medicine to understand. why certain
things in medicine are being blocked or don't
happen. And it turns out it's all through society,
right? When you look at just a simple example
that I heard recently is Expedia, the Expedia
website where you can go on and make your own
flight. The guy who developed that, I listened
to a podcast from him recently, he said that
they brought so many lawyers against this guy,
but he had the backing of Microsoft at the time.
He's the same guy who created Zillow, the real
estate website. When he tried to create Zillow,
they tried to shut him down every which way.
Every which way. Why? Because the real estate
industry had monopolized this data. They kept
it to their own selves. And he said, no, we're
going to. So now let's go to hospital care. There
was vitals .com tried to make public. outcomes
of hospitals for certain disease states, a stroke
and cardiac arrest. And because right now, if
you want to go check on what type of doctor Peter
Antebi is or whatever, you can go on vitals .com
and find out. It turns out that they sued vitals
.com and threw so many lawyers at them. Who did?
The hospitals did. Because they didn't want...
And they don't want the data to become public.
So I'm now not naive to tell you that the pharmaceutical
industry is so big and is so powerful, as is
the hospital industry. Just as another example,
the state of Florida had, for the second year
in a row, a bill going through the House and
the Senate to try and force hospitals to become
pediatric ready. Very simple. You find that only
14 % of hospitals are pediatric ready, and a
lot of kids are dying every year from non -ready
hospitals. They put a simple bill in there to
say, you must do these things to be pediatric
ready. It was killed again just two days ago
by the hospital lobby. Okay? So 100 ,000%, there
are people who want the funds and the revenue
to keep coming in at the expense of the health
of the American public. And that's just... That's
just how it is. And what does that mean to you,
the listener? You're going to have to go and
understand this and then take your own actions
and find the Jesses of the world who are going
to come and say, I'm going to present to you
different evidence for a healthier Peter and
Tevi, and we're going to personalize the care
for yourself because you're not going to find
this information anywhere else. And it's just,
it's unfortunate that that's where we are today,
that you have to, you know, You, James, have
to rely on your upbringing and your knowledge
and know -how because you're never going to get
the information you know today from a doctor.
I was never talked out of medical school. I think
that was a question earlier that I probably didn't
answer. They never focused on it. No one focused
on breathing. No one focused on sleep, right?
Your growth hormone is released in several times
throughout the day, most importantly at around
1030. So you probably should be in bed. So that
growth hormone can do what it's supposed to do
at that right time. If your sleep is off, everything
about you is off. That goes back to what you
focus on in the fire department, where cortisol
levels are off. All the levels are off when you
don't get the right sleep. When you go to the
doctor, they're not asking you, how was your
sleep? But most of us have, you know, I have
my aura ring right here. I have my Apple watch.
Every morning, religiously, I wake up. I want
to know how I slept last night. And so I now
focus on my sleep. I try to focus on exercise,
eating healthy. And I'm doing that without any
really any help. I'm just trying to figure it
out on my own, which is unfortunate. Well, you
mentioned about being in Palm Beach Gardens the
other day. You're in Palm Beach County. The 24
-72 revolution is really happening down in your
area. What are you hearing as far as, you know?
any kind of rhetoric around this change? And
then what is your perception if we go all the
way back to being able to make good medical decisions
on this kind of movement and the ability to improve
the paramedic and fireside as far as acuity?
I'll tell you a story that just happened yesterday.
I spoke to somebody who was on a 48. Why were
they on a 48, you ask? And you know the answer.
It's because they were on overtime, mandatory
overtime. So now they're at a 48 and they're
being asked to do things. So we had some crazy
calls yesterday. A lady who was 24 weeks pregnant
who is at the OB office. And when the OB looked,
she sees an amniotic sac with two feet protruding.
And she's feeling contraction. So just imagine
if we now had to deliver. or try to deliver a
footling breach of a 24 -week, you know, a lady
who's 24 weeks pregnant, and you're on a 48,
right? Just imagine how your lack of sleep, your
lack of ability to think cognitively and accurately
and precisely would then lead you to not perform
well, right? And then you have a bad outcome.
And because of your shame and your embarrassment,
you're not going to tell anybody. And that's
just another fire that's burning inside your
brain, telling yourself how badly you performed,
how incapable you are. And oh, by the way, you're
going to come back down in 48 hours and do that
all again. So I've talked to a lot of people
and everybody. who are the frontline folks doing
the job, they're all very in favor of it. The
people who are not in favor, the few people who
have been in favor of it are obviously the people
trying to figure out financially what this all
means, right? And they have their own method
of calculation. Some of them are not calculating
in the amount of overtime they're paying currently
to understand that it's basically a wash when
you actually get 24 -72s in. They're saying we
have to hire a whole other shift. They're saying
that now these paramedics want more money. And
by the way, they're doing less hours. But, you
know, you have great unions down here who are
fighting the good fight and their agencies. Now,
the nice thing about the 24 -72, and I'm preaching
to the choir here, is that once one department
goes to it and then another and then another.
There's no way that you can't go to 24 -72 because
you will not get any applicants. And so that's
the nice thing about this particular change.
It's going to force everybody to move to it.
And I think that's something that we're seeing
already. And it's just going to force people
in that direction. And now it has to be explained
well to the general public because, you know,
there's still... politicians and people out there
who don't understand the risk that you guys take
every day, the amount of strain, stress that
you have on these micro -traumatic calls, which
I call micro -trauma. And so I think that there
has to be some folks out there who are explaining
to the general public why not only do you deserve
2472, you deserve every dollar, you deserve...
many more dollars you deserve every dollar of
pension and um and i you know i can tell you
because about a year ago i think i told you this
a year ago i almost died when i was riding with
the fire department uh we got hit pretty hard
and um the only reason that i'm alive sitting
here talking to you today is because i saw the
car coming the ems captain i was riding with
didn't see the car and i yelled at the last second
and they pumped on the brakes Just enough that
they just demolished the whole front end of this
SUV instead of coming right into my door at 60
miles an hour. And I went home that day and I
said, you know, the general public just does
not understand what these people do. They just
don't understand it, period. And I am the biggest
advocate. I am the biggest cheerleader. I will
argue about this and fight this and debate anyone
on this topic for as long as I'm alive, because
this is really one of the hardest jobs in the
world. It's one of the most glorifying jobs in
the world, like yesterday's anaphylaxis case.
But when things go the other way, you're on the
other side of that coin. And it's a very hidden,
I wouldn't call it secretive, but very... It's
in the shadows because you're supposed to be
this hero. And how dare you talk about the bad
parts of your job when you're making all this
money and you have this great pension. And it's
this weird space that people are in. And I just
hope that the 2472s, as they come along, are
messaged the correct way. And maybe when you
make your film and your documentaries and your
docuseries, that could be explained. why that's
so important. I know that you're going to do
that. Absolutely. Well, firstly, I appreciate
your perspective because, I mean, you were right
in the heart of it. And it's interesting because
I do a presentation. I'm going to do one at the
FPF next week. And I don't do it very often at
all, just when it's a large audience. So I can
have that force multiplier element. But there's
one slide and it says, who's to fault? And it's
a picture of a ladder. And it's, can I ask the
room? And some of them might say chiefs or unions
or whatever, but usually they go, all of us?
I'm like, yes. So take the firefighter that goes
home, tells everyone, oh, we got the best job
in the world. I get to work out at the station.
I only work 10 days a month. And that's bullshit.
We've been telling this fairy tale for decades.
When you put it down on paper, we work 56 hours
a week. That's 16 hours more than the person
that says we shouldn't give. firefighters more
time off for example so you know when you actually
unpack it at every single level every one of
us has believed the kind of myth so it's not
blaming it's just getting everyone to go take
a step back evaluate what we've been saying and
let's kind of dig into the truth and the fiction
but then like you said i believe that there's
a revolution and it's beautiful and i know there's
a central florida department's getting very close
to to being the first in our area. And then Gainesville,
they've had amazing success so far. I know FSU
is doing studies now in Gainesville and Destin,
which I'll be hearing the results in a few weeks.
So yeah, this is really gathering momentum, but
it is that massive herd of elephants in the room
that is not the... you know, fix all, but it's
going to make a huge impact on all the things
that we've discussed, mental health, physical
health. I mean, all, all the things. So to hear
your kind of testimony from being in the heart
of it as an EMS director, I think that's very
powerful. Yeah. Yeah. It's a, it's been, it's
been a really the only way that you can get this
perspective. And I, let's remember, I was the
guy in the ER before I got into EMS who I was,
you know, the only thing I knew about EMS was
that the double doors would slide open. And another
stretcher would come in for just more patience
for me to see. No idea what those folks did.
I heard the same fairy tale stories that you
heard. And unfortunately, I'm not on podcasts
like this talking inside baseball about what
happens. And I don't think many people are telling
this story, unfortunately. I find myself not
going home or at dinner parties telling people
about, the inside baseball of ems because it
turns out they have they have their their thought
process of what it is and then here's i'm going
to go and pop their bubble and say oh by the
way it's not they do there's a lot of micro trauma
there's all this emotional stress and they have
no sleep and their cortisol levels they don't
nobody wants to hear that right um and so that's
that's a problem and that's why um this this
uh the tv show recently where the the pit there
that came out, um, was so, um, if you went on
Twitter, all you saw was finally, I can finally
explain to people what we really do and what
my day is really like. And that's, that's, that
was such an important thing. Cause I did the
same thing. I'm like, that's what we do right
there. Yeah. And that's what I hope is kind of
is going to be for our profession. It's not just
purely the modern day fire service. It goes back
in time and all that, but I think this is it.
And when I saw the pit, I was like, firstly,
I mean, for example, one of my biggest frustrations
during COVID is journalists being like, there
are people in the hallways of the hospitals.
There are always people in the hallway. Where
have you been the rest of the time? And the pit
shows the triage and talks about the hours and
hours and hours of waits and the assaults on
medical staff and the mental health issues and
the fentanyl. And I mean, just it was so well
done. And then you add in the fact that technically
they got it spot on as well. I mean, I think
it was such a breakthrough show. I really do.
It was. And they had great writers, you know,
Mel Herbert from MRAP in California, kind of
legendary educational figure, ER doc, who helped
them write the show. They had great pediatric
help, Sylvia from Children's of Pittsburgh. And
they really dialed it in to the point where even
for me watching the show, um again i haven't
done i haven't done a shift in a little bit here
but um it brought me right back to the my brain
was hurting after every show of like i remember
what it was like to come home from a shift and
be dead to the world after a 12 -hour shift not
a 24. dead to the world and i didn't want to
talk to my kids i just wanted to go to bed and
then it was you know it's it's it's very important
to show the public what really happens and not
just to say oh You're an ER doctor. You must
make a lot of money and not understand really
what's really happening behind the scenes. Absolutely.
Well, I want to make sure that we talk about
whole blood. But while we're on this kind of
physical mental health in a track, let's talk
about the mental health in the first responder
community. Before we hit record, we talked about
some of the people that we've lost in your area.
So let's give you the mic on that. Yeah, thanks.
I appreciate that. I mean, we. This is a huge
topic for me, so much so that if you come to
any of the paramedic school graduations, you
have two schools that I'm medical director for.
And at the graduation, I have all the family
there. And I go on about this topic of mental
health. Then at our department, I mentioned to
you earlier that we have so many things that
are happening, even like currently today, yesterday.
We have people at our departments who are talking
about, you know, mental health, the value of
sleep and, you know, really doing things the
right way and trying to kind of cleanse yourself
and having, you know, your life in balance with
religion, with friends, with family, with all
those things. And unfortunately, it's still a
problem in our departments. But unfortunately,
there are people who are in my agencies today
that are in pain, that are hurting, that are
under treatment, that are getting care. And I
always worry that we're not providing them with
the right resources. And to your point, you know,
we lost Bill, we lost Alex recently when I say
we, our South Florida community. And these really
legendary figures who... by all accounts, have
had legendary careers, like a career that anybody
would want. But for some reason, they chose to
take their own life. And you stop and say to
yourself, what are we missing? What is it that
is sitting there right in front of us that we're
not capturing? And I don't know the answer to
that, but... You know, these types of things
worry me because when you have someone like Bill
Gustin, who the funeral was so big, we went to
the Kaseya Center. That's where the Miami Heat
play, right? And we celebrated his life. But
I wonder how many people were sitting there in
that room feeling the same way and not being
able to have an outlet. And so that's why you
and I have talked about this. maybe we'll talk
about it here again, which is that there's so
many more things we could be doing. And so one
of the things that I know you're very interested
in, but something that we've actually implemented
here in both Broward and Palm Beach is the access
to ketamine. And this is for someone who's acutely
suicidal, who we know there's data to show that
ketamine can help you if you get it like today.
But if there's all these barriers or people are
not knowledgeable about it or they think ketamine
has killed Matthew Perry or whatever, then they
end up kind of putting all these barriers. And
then you have these people who need it, you know,
paramedics, firefighters who need it, but don't
have access to it. It's up to us as the leaders
of the department to say, no, we're going to
educate you on this thing. We're going to provide
immediate access to people to. ketamine, obviously
plus therapy at the same time. And now all the
other treatments that are coming down the pipe.
Why should we not have access to that? Why should
there be any stigma to a firefighter going and
getting, you know, the six to 10 ketamine infusions
over the three week period? There shouldn't be
any stigma to that, but people are slow to adopt,
but this is the future. You know, every department
in America. At some point in the future, we'll
have access to these other things that are currently
today not being given. We're just not giving
them access to things that we know work, that
they're studied with veterans that we know work.
And maybe it's big pharma that's stopping it.
I don't know. Things have to change. And I know
that you're much more into that world than I
am, but I'm a very big proponent of that, and
I'm going to keep fighting for that for my folks
so we don't have any more deaths that are unnecessary.
Well, going back to the big pharma, I think a
good example of the, for lack of a better word,
fuckery behind the scenes is the FDA refused
or denied. mdma to be used again as a therapeutic
you know not that you just get prescribed and
go dance around the streets but you sit down
with a counselor but you know oxycontin was approved
by fda and look what happened there you know
so the way i see this you know firstly as far
as contributing factors it's a new a number of
things and we all know for example sleep deprivation
is a massive contributor to mental ill health
so that's an easy easy thing to start making
a big difference is to give our first responders
more rest and recovery. You've got unaddressed
childhood trauma. Okay, well, at the front door,
rather than doing the MMPI, which does nothing,
let's have counseling from day one. Let's give
our probies, as well as the PT, let's give them
mental PT and give them an opportunity to offload.
Because if you became a first responder, there's
a good chance that you had some struggles when
you were younger. That's what makes you a good
firefighter or cop. but only you have to address
them. You have to work through them so you can
grow from them. But then from the therapeutics,
the kind of analogy I've come up with is you're
standing in front of the closet in your mind
and maybe talk therapy just wasn't the right
key for the lock. And so you're still standing
outside. You haven't got to the thing. So maybe
it's MDMA or psilocybin or ibogaine or ketamine
that allows you to open that door. And as you
pointed out, not alone. alongside with psychotherapy.
Now you've opened it. Now you can start unpacking
what's inside. And I think that's what we have
to understand is that some people, yeah, will
be able to walk into a room. They'll have a good,
good relationship with a counselor and they'll
be able to unload some things. And then that's
it. A lot of people I know have breakthroughs
because they didn't even realize it was in there.
It was so far locked away deep in their mind.
And this is what ketamine and some of these other
substances that were so demonized in the past
are showing to have amazing success. It's not
a magic bullet, but it opens the door to whatever
recess of your mind that now you can get to that
to use the princess and a pea analogy, the pea
beneath the mattress. I agree with you. And I
also think that. This is where the AI is going
to come in in a huge way because you'll be able
to have an AI that is able to provide feedback,
conversations, along with these other types of
treatments. And I think we're, you know, listen,
I've referred so many people to these ketamine
clinics here in our area. I visited all the ketamine
clinics myself. I shook their hands. I learned
their process. I learned who they were, how they
were trained, what their process is. where the
data is so now we we you know um we allow folks
to and again i know there's more than ketamine
but for now at least i don't have any access
to the psilocybin to the mdma you know therapeutics
if you will but um the world has changed from
when you and i were younger and from when our
parents were younger and um a great book that
that i read was um by a guy named Yuval Harari.
He wrote the book Sapiens, which is a great book.
Then the book that really hit me was Homo Deus.
He talks about why kids growing up today are
going to have massive amounts of anxiety and
stress compared to when we were younger. A lot
of it has to do with social media and all that's
out there today. change what we've done for the
last 50, 60 years. And we have to retool for
what's coming, what's actually here already,
and use the different tools, whether it be different
therapeutics, AI, different mechanisms, different
work schedules. We really have to completely
start from a blank slate now that we understand
more of the science and say, this is the way
we're going to walk into the future. And that's
hard for a lot of people. to do you and i are
different and people listening to this podcast
are probably different but there are a lot of
people who just do things because that's the
way we've always done it and that mentality is
going to have to change and it's going to take
ground roots effort and people to just change
it and then study it and publish it and then
over time i think we'll be in a place maybe in
five to ten years from now where this conversation
will be very different than the conversation
we had today and the one we had 10 years ago.
Absolutely. I was talking to someone yesterday,
Mike Cleland, the firefighter turned lawyer.
And I've been saying this recently, you know,
when we talk about the Bill Gustins and all the
pioneers of the past, they came up with bunker
gear, SCBAs, you know, easy IOs. I mean, whatever,
you know, obviously you're one of them with the
hand heavy system, but operationally, there's
a lot of things that are already. they're working
pretty well like a hose is a hose a ladder is
a ladder you know we've kind of got most of those
my generation our generation i think what we
can do as pioneers is change the human side the
shifts themselves the access to therapeutics
the fitness standards all these things so we've
got the operational side and we've got the guys
that will show you how to you know use a forcible
entry prop but now we need to help the person
in the bunker gear and i think this is where
my generation, like I said, the kind of 9 -11
-ish firefighters is what can we leave? What
legacy can we leave? And I think it's let's make
it healthy for the next group. Let's make suicide,
cancer, all these heart disease an anomaly rather
than an almost certainty that we're seeing at
the moment. Yeah, I agree with you. I hope for
that day to happen. Every year there's a walk
here in Miami called Never Walk Alone. And it's
because There was a firefighter from the city
of Miami who took his own life. And, you know,
it's unfortunate, but we have to continue to
shine light on this problem. You do an amazing
job on that, and I hope you continue to do that.
And we have to kind of be – we have to be your
force multiplier. And so as many people who are
listening today, you have to kind of fight the
fight with James. It's just like with me. I realized
that just because I wanted to change the world
of pediatrics, it didn't mean that I was going
to have people jump on the bus with me. And I've
learned that the only way things are going to
change is, unfortunately, when you have all these
people at the very top who are trying to stop
this type of innovation, it takes this groundswell,
grassroots efforts to just one by one, one person
at a time. is going to change the world. And
I fully strongly believe that today. I never
used to believe it. And that's why when people
ask me to go speak, and I still do a lot of speaking
engagements, even if there's one person in the
room, I'll speak to them. Because if that's the
one person who's going to be able to go and change
their community, then it's worth it for me. So
I still like doing things that don't scale. Because
I think it's You know, until you get to that
flywheel going, it takes a lot of hand -to -hand
combat. You've been doing this for a long time
and you're finally seeing the flywheel moving.
In healthcare and in anything we do, nothing
happens overnight. And you could be a TikTok
celebrity or a YouTube star or whatever, but
if you want to make the world change, you really
have to go find that one person and 10 more people
and 100 more people. And in 10 years from now,
you'll have 200 ,000 people who believe in what
you're doing. And then they're going to be the
future leaders of this place. And then they're
going to enact the right things. And I think
that's where we're in that place now where this
next generation is cycling through. And they
understand the problem differently. They see
the solutions differently. And now they're going
to enact and engage very differently than their
predecessors did. And I hope that. you continue
along that path because you've made big impacts
thus far. Yeah, I agree. I mean, vice versa.
It's all the people that have been beating the
drums. Like you said, there's just a knowing
of the truth. And I think mine comes from hundreds,
over a thousand interviews. And it's not that
I'm an intelligent person at all, but when you've
listened to so many people, yourself included,
and you see the overlap on the Venn diagram.
It's irrefutable by that point. And so that's
really what drives me. Speaking of progressive,
I just want to hit one more area before we wrap
up with some closing questions. Talk to me about
whole blood. That seems to be the next, you know,
exciting innovation in pre -hospital care. Yeah,
it is. It is. And I'm just excited to be on this
journey. And I tell all my firefighter paramedics,
I said, you're going to be talking to your children
one day. And you're going to say, you know, your
mom or your dad, we were one of the first people
to give whole blood. And they're going to be
like, come on, there's no way that whole blood
wasn't around forever. So we're in this moment
where, and I think we started with this, where
there are certain things that when I learn about
them and I see them, that they're so obvious
to me that it's the future, but that for some
reason the rest of the world doesn't see it yet.
I got to give a lot of credit to Don Jenkins,
John Holcomb, Phil Spinella, Randy Schaefer,
all like the OGs, you know, C .J. Winkler, who
actually brought it from the military. They fought
like hell to get it into the civilian world.
And then in 2019, we went and said, we want to
copy everything you're doing. And they said,
here, open book. And once we started giving whole
blood, so July of 2022, Palm Beach County, we
gave our first whole blood. And we had medics
who were going to retire, you know, I'm not sure
if I want to go into the drop, blah, blah, blah.
And then we started saving lives with whole blood.
Those people never want to retire. Like literally,
it is from a mental wellness thing. We had a
four -year -old kid in Palm Beach Gardens who
was in it. And I put this on LinkedIn a few months
ago. He was in a booster seat in the back. They
got hit from behind a 995 at high speed. This
kid ended up by the dashboard, still in his booster
seat. It crushed his leg to the point where it
snapped his femur, right femur snapped. No head
injury, no chest or abdominal injury, just a
femur fracture. Ashley, one of our EMS captains,
gets there on the highway. This kid is now unconscious,
and he's braiding down. She has been doing this
for a long time, and she will tell you that she's
held lots of people in her arms who have died.
In the same exact situation from hemorrhage on
the scene, that were alive who died in her arms.
She gets that whole blood out. She uses this
LifeFlow infuser. It's an amazing product. And
she gives him the right dose right on I -95.
And the kid literally wakes up, okay, starts
screaming. Starts going towards the hospital,
you know, 20 minute ride to the hospital. 10
minutes in, kid's braiding down one more time.
She gives the next dose of whole blood. Kid wakes
up, gets to the hospital. Kid's wide awake. Goes
to the OR, external fixator. He's out of the
hospital like a week later. Perfectly normal.
If I would show you the text, I would just show
you. And by the way, I have like dozens and dozens
of these texts. And I'm not asking for the text.
They're just sending it to me because everyone
knows that I've been so involved in Whole Blood.
They're like, Doc, this was the most amazing
feeling I've ever had in my career. I can't believe
that we're able to do this. Thank you so much.
This is the most incredible, amazing. It's people
who have been doing this for a long, long, long
time. who are finally getting people back to
life who are dying in their arms. And now we
have the data to prove it. So from New Orleans
to Washington, D .C. to Atlanta to Palm Beach
to Broward County, all of us have about a 90
% survival rate if we got the blood before you
were in cardiac arrest. If you were in a cardiac
arrest already, Palm Beach County, we have a
0 % survival, unfortunately. But 90 % survival
for everybody else. You know what that is? So
that's number one. So whole blood is here. The
only things that people should be understanding
of, and it's a whole other podcast we can have,
which is that there's not enough whole blood
today to supply every EMS system. So that part
of the equation has to be fixed. And there's
a lot of things we can do. I'm not going to go
into that today. But what's coming in spring
of 2026 is something even more amazing, which
is a company who has figured out how to spray
dry plasma. So the whole blood costs us about
$650 per unit. All the consumables cost us another
$300. We're in for about $1 ,000 a patient. This
plasma thing, they take this plasma, which is
the yellow fluid that bathes the red blood cells
in the platelets. They isolate the plasma. This
company has figured out a process to dehydrate
the plasma, put it into a moisture -free bag.
in crystals. So imagine having like a normal
saline bag that's completely empty and it feels
empty. It feels paperweight. It comes with a
200 ml sterile water bag that you add it to the
crystals at the time of use. It takes about four
minutes. And now you have a full bag of plasma
with all the factors, all the clotting factors,
all the proteins you need. And you'll use it
for trauma, TBI, anaphylaxis, sepsis, burns.
And you're using a real blood product that has
a two -year shelf life that's going to cost somewhere
around $100. And that's going to be massively
available. And so whole blood and plasma, which,
by the way, I have both of those live today.
The plasma I'm using today is liquid plasma,
$60. So if you get into an accident in Palm Beach
County and you have a traumatic brain injury,
you're going to get plasma. If you're hemorrhaging
because you got stabbed, shot. a car accident,
you're going to get whole blood. And I got to
give credit to my leadership. I got to give credit
to my fire chief. I got to give credit to the
county commissioners because we are paying for
all this, right? We're not getting paid back.
It goes back to the conversation we started off
with, which is that we are spending a thousand
bucks. We're collecting maybe 400 if we're lucky.
And the federal government is saying, you know,
sorry, can't help you. I mean, There are people
trying to make moves to change that. But the
hospital, that same hospital who would have given
the same whole blood would have charged, you
know, six grand to the insurance company. They
would have made hundreds of thousands of dollars
on those patients. But the social care, socialized
medicine, the safety net of the community is
losing money. So I am here not only to push this
concept of whole blood and plasma. But the push
that the fact that EMS is the life -saving unit
in our communities, we're giving antibiotics
for sepsis, which has never been done before,
which is going to, once the studies come out,
and I just published my study, but once a big
RCT from Canada comes out, next year, everybody's
going to be moving to antibiotics for sepsis.
We do finger thoracoscopy. We use ultrasound,
the whole blood, the plasma. Look at all the
stuff that EMS is doing. The rest of the world,
the rest of healthcare doesn't get it because
they have the blinders on. When they hear EMS,
they shut their brain down and they have no concept
of what we do. I'm trying to change that by getting
more out there on social media to try and expose
what your EMS system can do. But it's going to
rely on the people listening to this podcast
who don't have those things to go fight like
hell to get it. To go fight like hell to change
the 24 -72. To fight like hell to get whole blood
and plasma. To fight like hell for the profession
that you love, right? And I think it's happening.
And I'm hoping that I can continue to inspire
more people to really own it, that we are the
people who are the ones who are saving lives.
The hospital just takes the baton and they keep
that alive person alive, hopefully. enough for
them to walk out of the hospital so it's an it's
an amazing profession the people are just incredible
salt of the earth common sense just great people
and i have really found the place where i need
to be in life and i'm just very grateful to know
people like you and to try to spread the word
when i kind of reflected back as i got deeper
into my career Some of the things that we were
told, you know, that's the way we've always done
it. I question. So I'll give you a fire example,
a car fire. I've never seen someone drive up
to a fire station and say, thank you for saving
my car. I got it all restored and here it is.
Like every car fire is a dumpster fire, but it's
also a class B dumpster fire. So it's a, you
know, petroleum dumpster fire, yet we use war.
And I've watched, you know, numerous times using
the entire tank of engine war, just to try and
put out a fire as the, the petrol was kind of,
you know, going down into the drain, still on
fire. And, you know, so. And clearly, when you
put foam on it, it goes out straight away. Or
even people laugh at it, but the Europeans have
a blanket. They'll carry over, and it goes out.
Now, that's not the lithium -ion batteries. That's
another entire thing. But we were always told,
put water on it. But then when you're in fire
school, water is for paper and wood. It just
doesn't make any sense. And you're not saving
anything, so you don't need to be right up on
it either. On an EMS point of view, I'm not the
smartest tool in the box, or the sharpest tool
in the box. I can't even say that phrase right.
I always remember thinking with the trauma, if
we're adding saline and there's no red blood
cells in saline, why are we adding saline? You're
just diluting the blood. And this was a long
time ago, I was thinking this. So talk to me
about the pushback from the naysayers. And then
also I'd love to hear what is the gold standard?
Because I had someone on recently, they didn't
have it on their... on their ambulances, but
they had it on the helicopters. So what is the
ideal? Is it blood on every rig? So I guess,
firstly, how did you overcome the opposition?
What was the opposition? And then what is the
gold standard that we're all aiming for in an
agency? Yeah, well, so it's interesting. Whenever
you're first to do anything or one of the first
to do anything, the first people say, we've never
done it this way, therefore it can't be true.
So there's a whole wave of those people. Then
there was no data out there to suggest that this
works, except there was a lot of military data
that we had to kind of bring forth to the civilian
world and show people. That's what we used to
prove the point at first. Now that we have a
ton of civilian data, it all looks exactly the
same. The next person to start tomorrow will
not have a problem, at least exposing the fact
that, hey, whole blood is the way to go. The
problem with it is that it's expensive. EMS loses
money everywhere. So now, hey, chief, I want
to cost you another 50 grand a year on something
that you don't have 50 grand for. There's all
this paperwork, FDA requirements, QA, you name
it, it doesn't end. And so people who are, if
you're not a department that can flex its muscle
and do all those things, then it's very difficult.
So I think that the biggest barriers today are
who's paying for it, if we can get it paid for.
We're good. If we can swap it with the hospital
so we don't waste it, that's another thing. And
now more and more people can just give you the
toolkit to say this is how you do it. So I think
those are the three main things. Then you have
the supply issue, which is a big one, not enough
supply. And then, you know, I think that the
naysayers are typically the people who the whole
blood. on the ground units are taking away the
business of the air units and that's kind of
the most of the people i see coming out against
whole blood are the people who were carrying
whole blood dropping a helicopter and grabbing
the patient charging them 15 000 and then um
and then and now now we're saying oh we don't
need you helicopter we're doing it ourselves
and then finally the last question is um it should
not be on every ambulance unit it should just
be on a supervisor vehicle so like One city needs
to just have one vehicle with the blood, and
that vehicle should just be dispatched for the
Delta Echo calls that would be a suspected hemorrhage,
right? So it's coming. It's here. It's going
to be here. It's not going away. Too bad, so
sad for the people who don't think it's happening
in real time. So Peter, for people listening.
Where can they find Han Tevi and then where can
they reach out to you online if there's any other
places? Yeah, so I would say I'm on LinkedIn
and you can connect with me there and we can
text there back and forth. That's the best way.
I'm there a lot. Han Tevi is just hantevi .com.
And we also are on YouTube and I do a weekly
webinar for EMS on the Florida NAMSP YouTube
channel. But I would say start with LinkedIn.
I post quite frequently. And I hope to engage
with people there and would love to have people
connect with me and give me their thoughts on
today's podcast or anything that they think I'm
missing. I always want to learn from others.
Well, I want to thank you so much. I know you've
got to go now, but thank you so much for coming
on and not only talking about the technical side,
but having that courageous vulnerability with
some of the stories you've told as well. Thanks
for giving me the space to do that. It's definitely
therapeutic for me and I appreciate it. I appreciate
you doing that. So it was great to see you. And
hopefully it's not 10 years till we see each
other again.