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Hello everyone — glad to be here. I recently retired after about 30 years in EMS, serving as both a paramedic and EMT instructor, and later running an EMS education program for a state fire academy. Over the years I’ve been involved in everything from street-level response to curriculum development, instructor training, and continuing education. My academic background is in instructional design and course delivery, so I’ve always been particularly interested in how we teach medicine—not just the content, but the methods we use to help providers actually retain and apply what they learn. These days I spend a lot of time working with peer support programs and responder wellness initiatives, and I still enjoy contributing to conversations around EMS education, leadership, and the long-term sustainability of people in this profession. Looking forward to learning from the group and contributing where I can.

I am an Advanced Care Paramedic from Alberta, Canada that has practiced 17years with origins in rural ground EMS(10yrs) and now fixed wing critical care for the past 7. I have a deep passion for continuing education and I'm privileged at work to be surrounded by many like-minded individuals. In the past, I have been an EMS instructor at one of the academies that I took my initial training through and presently I work with our work-place educator to facilitate training of our roster. I'm excited to join the learning environment here as we share our knowledge and experience.

Early in the morning, an ambulance is requested to a private residence after a colleague has been unable to reach the patient prior to work. When the door is opened by a family member, the patient is found lying in bed and appears significantly unwell. The patient is a 42-year-old male with a known history of type 1 diabetes mellitus. He is drowsy and difficult to engage but responds weakly to verbal stimuli. He appears pale and diaphoretic, with rapid, shallow breathing. A faint sweet odor is noted on his breath. His airway is patent, and he is breathing spontaneously. Respiratory rate is 24 breaths per minute. Heart rate is 110 beats per minute and regular, blood pressure is 115/70 mmHg, and oxygen saturation is 97% on room air. Capillary blood glucose is measured at 28 mmol/L. Further examination reveals no signs of trauma. The patient has dry skin and dry mucous membranes. According to family members, he has experienced nausea, abdominal pain, and reduced oral intake over the past 24 hours. He uses insulin daily, but it is unclear whether he has administered his usual doses during the past day. Questions 1. Which findings in this case suggest diabetic ketoacidosis, and why? 2. Which prehospital interventions should be prioritized to stabilize the patient prior to hospital arrival?