The call comes in just after midnight.
Middle-aged patient. Shortness of breath. Altered. Blood pressure trending down.

There’s no lab work. No CT scanner. No respiratory therapist or intensivist down the hall. Just a two-person EMS crew, a limited set of tools, and a patient clearly heading in the wrong direction. Every decision matters: how fast to ventilate, whether to intubate now or wait, whether fluids will help or hurt, whether staying on scene for two more minutes is the right call.

This is where we live, every single day.

And yet, much of the guidance we’re expected to follow was never written for this moment or this setting.

For decades, EMS has been asked to apply science that was built for hospitals, not the prehospital environment. National guidelines, especially around resuscitation, have advanced care, but they’re largely based on in-hospital data and later adapted for the field. We’re left translating that guidance in environments that look nothing like an emergency department.

That matters.

We’re not just “early hospital care.” We’re a distinct clinical discipline with unique constraints, and a unique opportunity to change outcomes before the patient ever reaches the door.

When guidelines don’t account for the EMS environment, we end up building workarounds or relying on experience instead of evidence. Prehospital care needs guidance built for early decisions, real-time physiology, and the reality of how we actually work in the field.

At my departments, and through my work at Handtevy, it became clear that waiting for national guidelines to catch up wasn’t an option.

That realization led to the development of the Pediatric Resuscitation and Readiness Course (PRRC), built specifically around how EMS clinicians think and perform under pressure. Pediatrics made the gap impossible to ignore. Our clinicians were being asked to deliver high-risk care using guidance that was never designed for the field. Instead of continuing to adapt hospital-based education, we chose to build something prehospital-first.

That same philosophy is now expanding.

We’ve just finalized our newest course, NROC: The Newborn Resuscitation and Obstetric Course, designed specifically for EMS clinicians who manage deliveries and newborns before hospital resources are available. In early 2026, we’ll begin work on HEART, an adult resuscitation program focused on EMS-specific physiology, ventilation, and decision-making. This isn’t about replacing ACLS. It’s about building education that reflects what EMS actually does.

Real change doesn’t start with another committee or consensus statement. It starts with clinicians and instructors who live these moments, and who are willing to ask whether the science truly fits the setting.

We deserve evidence, education, and guidelines built for the field. It’s time for our profession to take ownership of the guidelines we follow, the science we apply, and the outcomes we’re responsible for.

The work starts with us.