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Fire and EMS providers are often first on scene for rapidly evolving medical emergencies. This session of the AdventHealth Elevate EMS Series focuses on adult endocrine and toxicological emergencies, emphasizing the vital role engine companies and transport units play from initial contact through patient handoff.

Presented by Jeremy Padgett and Shane Stone—paramedics turned critical care nurses—this session connects prehospital decision making with what occurs during the inpatient phase, highlighting how early assessments, airway management, medication choices, and transport decisions impact patient outcomes.

Designed by clinicians with prehospital experience, this training delivers practical, real-world education that strengthens the continuum of care from the field to the hospital.

This training brings together academic excellence and frontline experience to deliver high-impact education tailored to EMS professionals.

Objectives:

Endocrine Emergencies - Jeremy Padgett, RN

• Differentiate DKA, HHS, and euglycemic DKA using presentation patterns and trigger/medication history (including SGLT2 inhibitors, reduced intake, and insulin interruption). 
• Identify thyroid storm features that commonly mimic sepsis/toxicologic illness (hyperthermia, severe tachycardia, CNS dysfunction) and prioritize supportive stabilization and rapid transport.
• Recognize adrenal crisis risk and presentation (shock with vomiting/weakness, possible hypoglycemia, chronic glucocorticoid exposure or known adrenal insufficiency) and prioritize time-sensitive stabilization and destination decisions.
• Perform a focused endocrine emergency assessment appropriate to EMS scope: airway/ventilation, perfusion, temperature, glucose trend, ECG monitoring, and targeted medication/trigger history.
• Initiate evidence-aligned prehospital stabilization for suspected hyperglycemic crisis emphasizing ABCs, cardiac monitoring, isotonic fluids per protocol, and avoidance of glucose-anchoring errors. 
• Apply current resuscitation priorities when endocrine illness presents as peri-arrest/arrest, while addressing reversible causes and expediting definitive care.
• Describe what occurs in the hospital from ED → ICU/stepdown → transition → discharge for DKA/HHS, thyroid storm, and adrenal crisis.
• Identify high-risk features that warrant rapid transport and escalation to a higher level of care (persistent hypotension, worsening mental status/airway risk, severe hyperthermia, unstable tachyarrhythmia, poor response to initial resuscitation). 

Toxicology Emergencies - Shane Stone, RN

• Explain a practical EMS approach to suspected poisoning (toxidrome-first, trends, co-ingestions, delayed toxicity). 
• Apply case studies (acetaminophen overdose and polypharmacy overdose) to identify threats and EMS priorities.
• Use Poison Control early in unstable/unknown tox cases and incorporate recommendations into practice.
• Stabilize toxicology emergencies using basics: airway/ventilation and perfusion first (ABCs), with temperature-aware care per protocol.

Session 2 Agenda: