Spiked Out
Welcome to the Spiked Out Podcast - your go-to for real stories, real people, and real insight from the wildland fire world. Brought to you by The Journeyman, we interview seasoned pros, share education, tips on getting certified, landing jobs, and making the most of the season. Whether you're already on the line or just getting started, we've got you covered. Tune in and get Spiked Out with us.
Spiked Out
The New DEA "Thing" And What It Means For Wildland Fire EMS
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A firefighter gets crushed by a falling tree miles from a road. A medic knows exactly how to control the pain and protect the patient’s body from spiraling stress, but the medication that makes it possible can’t legally cross the next state line. That’s not a hypothetical, it’s the operational problem we’re staring at after a new DEA interstate rule tightened how controlled substances can travel with EMS teams.
We sit down with Joe Decker from Remote Medical Rescue and Dan Blaul from All Terrain Rescue to explain how REMS teams support wildland fire operations, why remote rescue is fundamentally different from city EMS, and what “hours of patient care in the woods” really looks like. We unpack the rule change, the cost and brick and mortar hurdles tied to multi state DEA registration, and why rapid deployments across the West don’t fit neatly into the current compliance model.
Then we get blunt about consequences: pain management, ketamine, narcotics, and benzodiazepines are not luxuries when you’re packaging a femur fracture, treating a seizure far from a hospital, or managing critical procedures in an austere environment. We also talk about moral injury for providers forced to watch suffering they could normally relieve, and why this could push the standard of care backward for firefighter safety and patient outcomes.
If you’re a firefighter, medic, medical director, or someone who cares about wildfire medical response, listen, share this with your crew, and help raise the volume with decision makers. Subscribe, leave a review, and tell us what change would protect patients fastest?
Find the article here:
https://pmc.ncbi.nlm.nih.gov/articles/PMC6301399/
Find The Journeyman here:
https://livetjm.com/
Find Minuteman EMS here:
https://www.minutemanems.com/
Find Remote Medical Rescue here:
https://www.remotemedicalrescue.com/
Find All Terrain Rescue here:
https://www.allterrainrescue.org/
Blog 1
https://www.livetjm.com/blog/LIS4U8mscxKpEjHicSGq
Blog 2
https://www.livetjm.com/blog/7NQcizXnQrwTkJJrmaFe
[00:00:00] Moral Injury From Untreated Pain
[00:03:00] What REMS Teams Actually Do
[00:06:10] The New DEA Interstate Rule
[00:09:55] When Pain Control Prevents Death
[00:12:25] Real World Scenarios Without Narcotics
[00:16:12] Why Fixing This Takes Time
[00:20:40] How To Help And Where To Connect
One thing the doctor said that I hadn't thought of that I was like, wow, that's really something, is uh the moral injury to our providers, because now they don't have that tool. Like, if you're a paramedic and you know you need to do this to this person or stop their pain and you can't stop their pain when you normally could when you're working back at home. Yeah. Like that would that would bug me.
SPEAKER_03I mean, if you got a pack of wound on a patient that's got a you know a deep bleed somewhere in a junction or something like that, and you can't give them some ketamine to dissociate them or something, that's not gonna drop their pressure. Like, imagine the pain that's involved there, and you have to listen to your patients scream and cry and be uncomfortable for hours on end. Because these medical calls on a wildland fire, they're not over quick. We can have these patients for hours at a time.
SPEAKER_05Tyler with the Spiked Out Podcast and Minuteman EMS. Brennan's here as well, but I'm joined by my friends Joe Decker of Remote Medical Rescue and Dan Blahl of All Terrain Rescue. Hi. Uh why don't you guys first tell us a little bit about your companies and then we're gonna hop into some things we're all facing together.
SPEAKER_03Sure. Um Yeah, I'm Joe with Remote Medical Rescue. Uh we work predominantly with the Forest Service, uh providing medical care, uh, different avenues. Uh specifically started with REMS teams, which are kind of a remote medical uh rescue team, uh predominantly rope-based and kind of bridging the gap between the pavement and uh getting firefighters from the location where they're at to that pavement to definitive care. Um we've been in service for five years now. Uh this is year five with the company, uh, that I was hoping I was gonna be able to step back and work a little less, and it hasn't worked out that way. I seem to be working more every year. Uh recently started so running some single resource stuff. Uh I come from a structure fire and a flight medic and a service record in the Marine Corps. Um fidelis, don't be jealous. Yeah. It's uh been in public service one way or the other my entire life. Um yeah, as far as things that are struggling right now and are a neck of the woods, you know, the whole DEA thing that's you know come to light with the March 9th and uh the not being able to cross state lines and really affects us heavily. Um because you know, we respond all over the West Coast, specifically, Midwest areas, sometimes even over to the East Coast. And if we can't take the tools we need to do our jobs definitively, um and at best practice, I I feel like it's uh not only a disservice to forest service and our patients, but to ourselves too. I mean, we do this at a high standard. I know everybody at this table, and most people at this conference just do this at a high standard and are really proud of the work we do. So um and passionate about taking care of firefighters, exactly.
SPEAKER_05Yeah. All right, Dan, how about uh you tell us about you and your company?
SPEAKER_01Uh Dan Bowell with uh Al terrain rescue. Uh my background is started in fire and wildland fire forest service, did that for about 10 years. Before moving over to a structure department, uh where I got involved in technical rescue there. Um then, you know, I was discussing before how uh there was really no medical in wildland fire. Uh I was paramedic as well as technical rescue in the structure. And so I had the wildland background, the technical rescue, and then also being a paramedic, and I was like started hearing about these REMS teams out there, and I was like, hey, it's I think I can put that together. And I have actually learned a lot though, you know, actually the structure side of the REMs uh or the structure side of technical rescue doesn't translate over directly to REMs.
SPEAKER_03It doesn't. I came down the fire path too, and like and luckily I was on a search and rescue, you know, based helicopter kind of you know, wide areas, and like I got exposed to a lot of like light rescue before I came, and I had made that jump before I got into REMs, but like I'm sure when you first jumped into REMs, you were like, hey, you know, we're doing all the same stuff we're gonna do as you know, rope rescue at the fire department. Then you went, ah crap, this is a little different.
SPEAKER_01Yeah, foundation's the same, but then there's definitely some big differences. So being part of this group, this community has uh allowed me to make adjustments as far as medical and rope and all that stuff. And so I've been learning over the years, but yeah, so now my fourth season, and yeah.
SPEAKER_03It is all the same techniques and the same things, it's just smaller dynamiter and different reality that the the what it is longer time with your patients and that kind of stuff.
SPEAKER_01Yeah, just to piggyback off of that is you know, my background is I was in the forest service as a violin firefighter for almost 10 years before going over to a structured department where I got into technical rescue, and I remember back in the days in the Forest Service, medical was an afterthought. Like not like anybody here got medical experience? Cool, you do go grab the first aid kit off the truck, and that was the amount of medical or EMS that we had on fire. So to see it grow into what it is today, where now it's pretty robust out there, right? With the RAMs and everything and all the lessons learned over the years. Um to see the VA thing, it's kind of like all these steps forward, and now we're hit with this, and it's kind of you know taken multiple steps back, which is super frustrating.
SPEAKER_03Um especially on such short notice. On no notice, really, you know. I I mean I got a little bit of a head start on this because my medical director went to a meeting for uh so they're like the national EMS board or something, I don't know, they're part of, and they told me at the end of the year, like, hey, there's gonna be some major changes coming. This is a big thing, and I like I didn't know what they were even talking about at the time, and it wasn't until the beginning of this year when it got dropped on me, like, hey, these are the changes, and it's coming down through the Forest Service, and I was like, How does that make sense for EMS period as a whole? Like community, you know, you know, any kind of aid or you know, flight past state lines or mutual aid, you know, between Arizona and California, or like it just it doesn't make sense at all. It's gonna kill EMS as a whole. Uh and it just it's a rule that doesn't make any sense.
SPEAKER_05Um and I don't want to clear up that rule. We've just been saying DEA thing, which I think it's gonna be called now just the DEA thing. But basically we'll help each other through this. But on March 9th, uh new rule came about that uh you cannot cross state lines with narcotics unless you have a DEA license in the state you're crossing you came from, the state you're crossing to, um as well as an EMS license in that state.
SPEAKER_01Tens of thousands of dollars, and probably logistically, like if you go state by state, it's a lot of people.
SPEAKER_05I have to have a brick and mortar location in that state.
SPEAKER_01It's not even realistic, really. You can do it if you even if you wanted to.
SPEAKER_03If you gotta cross through five states to get there, you've got to have a DEA license with a brick and mortar that meets all the standard, you know, criteria to have a DEA license in that state, which is a huge expense, you know, um just to get to the fire. Yeah, you know, whereas like with hurricanes and things like that, natural disasters, which I think that's what they should do, they should classify wildland fire as a natural natural disaster, and then those rules kind of change a lot, and it makes us point of origin to point of origin, that's our you know, point of care, and then back to our state.
SPEAKER_01And I like what you guys were I saw you guys put up some posts and stuff about like you know, pain management's a human right, you know. Like that is huge for the care of firefighters when they're out there, and the level of care you know goes beyond and it could be a life-saving thing, and nothing. Absolutely. Absolutely. So it's a big deal uh that it's good that this has been thrown in our laps. Not just REMs, right? Like it's what we do, but yeah, every all medical that now shows up to these wild-on fires is gonna be severely uh handicapped.
SPEAKER_03Yeah, we're we're not all just like rope rescue technicians and instructors here at this table. We're also microcare flight medic. Most of us are medics, EMTs, bearing different levels of education. Um, and yeah, pain management can absolutely save your life. If you're having an MI and you can't control somebody's pain, you can't control that vasoconstriction and that pain reaction, you're decreasing you know, blood flow even worse and killing tissue, and you know there's there's a million different applications where this could be a big problem, or you know, you've got a pneumo or something and you've got to do a finger thoracostomy. I don't want to be the guy that has to do that without some ketamine or some dissociative, you know, or if God forbid you gotta pop a crike in somebody and you're gonna you're gonna do that with tordol? No, it's just not gonna happen.
SPEAKER_01Cardiac, you know, and so every year. So we're you know taking away a huge tool. Yeah.
SPEAKER_05And then my story, I had a seizure on the fire line, and we had Madazzalam, uh Russett on the REMS team. I had a second seizure, so they had to administer that. And as you guys know, as medics, like if someone has one seizure, that's one thing. But if they had a second one, they might have just a bunch of recurring ones. Yeah.
SPEAKER_03That was hours from the hospital, so I could have been hours from the hospital without uh and that could have been a lot of hypoxic damage, you know, that could have made your outcome a lot.
SPEAKER_04He may not have got on a bird, right? If the weather smoke was there, now he's going by ground for three, four hours, and you're telling me that we can only use Kepra? Yeah. May not be the best option.
SPEAKER_01And it's frustrating because it's like, you know, the Brahms was born out of like lessons hard, lessons learned, right? Like the palm. Out of deaths. Yeah, out of deaths. It didn't change until it was like, oh, okay, look at this tragic after the fact. I feel like this is and the tough part is there's no like individual to blame. This was, I guess, a law that was passed in 2017 they were saying, and now it's just been defined and implemented, and so it's kind of thrown in the laps of everybody. But I know there's a lot of people working behind the scenes to try and get past this, but it doesn't seem like there's so you start getting the word out, which is why it's awesome because I mean this like it does like people need to hear about this because it's coming.
SPEAKER_03Yeah, it's yeah. Yeah. Well, they saw in 2017 this this actually has been not a proposed but an actual, you know, uh rule since 2017 when it came out. It just wasn't enforced at all.
SPEAKER_02Yeah.
SPEAKER_03Uh because they saw all the problems it was going to cause, and then they have this new meeting, and I understand their whole point of like trying to lessen diversion is like, you know, the reason why they're mainly doing this, but it's not going to lessen it in any way, and like the rule was kind of went stagnant for you know almost a decade for a reason. Um and now to kind of pull it back out, and like uh the CIA can't even carry medications with this new law. Like to treat the president of the United States.
SPEAKER_04Like, come on, are you kidding me? And it's not like the DEA is doing this maliciously by any intent. I just think it's so far down their totem pole they don't have enough industry expertise to have made the right.
SPEAKER_03And they're just making it really hard to talk to them, period. Like anybody, like to get a uh, you know, as Dr. one of the medical director doctors, um, that I'm just not gonna name because I don't know if we should be doing that around here. Um, you know, they they can't even get a meeting with them on the phone unless they've got two people of the same GS rank, and like like it's an authorized phone call, and then like nothing can go via email, everything has to go via snail mail, and you know, you just can't get meetings with these people. And I mean, it's that I mean, up at the White House level, and they're still having trouble talking with the DEA over this. Like it's like how much noise do you have to make and say, hey, this is gonna kill UMS and cost lives? You need to reconsider this or at least make some addendums before they listen and hear it. You know, and the DEA, they're not medical practitioners in any way. You know, the the they they need to listen to the medical practitioners in the EMS and the emergency medical world at, you know, before they make a rule like this that affects the way that we treat our patients and standard of care.
SPEAKER_05Yeah, I just wanted to reiterate to the end-level firefighter out there, like what this actually means for you guys, and it means that your paramedics now are not gonna be able to carry like the medicine to stop your pain if you have a tree fall on you, or if you break your femur and now your hand a hand crew's gotta carry you out four miles and you have no pain medicine, or you have a seizure, or any all these other things that get a little technical medically, but we don't have those medications for you guys because of this regulation. Because it's it's a liability. It's kind of almost like, well, you probably could, and you'd probably be okay, and whatever, but then you know everything. Exactly.
SPEAKER_04It's a risk to your business and it's a risk to our providers that we send out there. They could lose their licenses just by trying to provide good care, and that's not fair.
SPEAKER_01And I gotta say, like, you know, being in this group and watching us all get the news kind of at the same time, it was it was pretty impressive that everybody was like, What's the workaround? There's always a workaround, there's always a loophole, and everybody was, you know, brainstorming as much as they could because everybody wants that level of care out there for the firefighters and we're just stuck with no there's really no workaround or loophole.
SPEAKER_04Yeah, especially for this year. And like you said here, especially for this year. If you're gonna do it right, it's gonna take a lot of logistics, a lot of initial investment, and many, many months to even get approved and inspected.
SPEAKER_03Like it's and there's a lot of people working on it, but they just didn't, we weren't given enough notice to work on it. I know my medical director is working really hard on this. You know, as soon as I told them about it, they got on the phone and they got some pretty high-level people involved. But again, it's just that the rate the DEA works, like I don't see you can only do so much. And the the the timetable's gonna be way slower than their reaction time to put it in into place, which has already passed, you know.
SPEAKER_01But we are working on alternatives.
SPEAKER_03Yeah, we are working on it. Yeah, you know, we're we're talking about other non-controlled substances that we can use, you know, in conjunction uh with different medications to treat the best we can, but they're still not best practice at all. Um will they s possibly save your life? Yeah, will they possibly make you a little more comfortable? Yeah. Um, but they're they're not, you know.
SPEAKER_04Not to the level you need out there.
SPEAKER_03Yeah, they're not ideal. They're not ideal, then they're not in the patient's best interest.
SPEAKER_05One thing the doctor said that I hadn't thought of that I was like, wow, that's really something, is uh the moral injury to our providers, because now they don't have that tool that like if you're a paramedic and you know you need to do this to this person or stop their pain, and you can't stop their pain when you normally could when you're working back at home. Yeah, like that would that would bug me.
SPEAKER_03I mean, if you got a pack of wound on a patient that's got a you know a deep bleed somewhere in a junction or something like that, and you can't give them some ketamine to dissociate them or something, that's not gonna drop their pressure. Like, imagine the pain that's involved there, and you haven't listened to your patient scream and cry and be uncomfortable for hours on end. Yeah. Because these medical calls on a wildland fire, they're not over quick. We can have these patients for hours at a time. You know, there was a rescue a year or two ago, there was a 12 or a 14-hour rescue. I'm sure you guys know the one I'm talking about. But like, that's a long time out in the field. And we can have some long patient care episodes where if you're in pain like that, it's and you just yeah, at the provider level, and just the trauma that that's also going to induce in the patient themselves, it's the next level, you know.
SPEAKER_05Oh yeah. Check out that uh article if you guys and then the listeners about the the NAHU put it out that uh pain management is a human right, is like a study in all this written by doctors, and yeah, that it's associated with like longer healing times when you don't get pain management, uh poorer outcomes in general, uh PTSD, more stronger PTSD uh link to the incident.
SPEAKER_03So you imagine, yeah, imagine having to RSI somebody, and all you can do is paralyze them, you know, and you you have to take an airway or something like that. They're they're awake through that entire thing. You know, I've known people that have been in that situation and have spoken to them, uh, and it is one of the scariest things they've ever been through in their life. You can't breathe on your own and somebody's digging around in your throat. You know, that's it's a pretty scary thing.
SPEAKER_04Now add moving that patient through Austrian environment, right?
SPEAKER_03You know, it's it's already like we work in an extremely difficult like area. Like performing medicine in the woods where you gotta move a patient through, you know, train that's difficult to move anybody through, even just bumping the back of a UT creates a lot of pain. If I've got a fractured ankle and I'm getting bumped around in the back of UTV and I don't have a way to trace that, and it's an hour and a half ride to the drop point just to get to an ambulance or to get to the next person who's gonna take me to my next leg.
SPEAKER_04Who still won't have it, yeah.
SPEAKER_03Who still won't have it, yeah. Like it's uh I don't know. It's it's not the right answer, and I uh I think something needs to be done faster. And uh I'm hoping people, you know, I know as an NWSA and stuff like that are trying to get involved at the White House level and get some senators and things to, you know, see that that there's a huge gap there, you know. Um, like myself, I also came from a flight background, and like I couldn't imagine, you know, I leave my home state and we would do it all the time and fly to states all over the country, whether you're in a fixed wing or a rotor, and oh well, you just crossed out of Arizona, I can't give you any narcotics anymore. Or actually, I can't even fly you out of Arizona, I can't get you to that trauma center that's just over the border in Utah anymore, because we're not licensed to get over the border with those medications that we're currently dripping in you to keep you sedated with that tube down your throat. Yeah, yeah, it's a huge dilemma. Um, and again, and it's why that rule has sat for so long and not passed.
SPEAKER_05Yeah, well, we just wanted our audience to know about it because it's ultimately affecting you, the firefighters who are listening, and the providing medical yeah.
SPEAKER_03If you know anybody, if you have the ability to speak up about it, or if you have a family member that can get involved that has a congressman in their you know, something like that, I would get them involved.
SPEAKER_05Reach out to us uh on Instagram or wherever uh and we'd love to talk because we do need help taking this to the next level. So if uh anyone in our audience could help us out, that'd be great. Well, these are both uh awesome guys. I know they have awesome companies. I've never heard a bad word said about either of them. So if uh I don't know if they're hiring, but if they are, they're gonna be doing it on the journey man, so find them there. Absolutely.
SPEAKER_03Or check out their Instagrams, Instagram or website. Ours is simple, it's remote medical rescue.com. You know, go to click on uh employment and fill out an app if you're interested. Thank you guys.