Meet Your New Medical Director! *spoiler - they aren't human*
– By #School of EMS
We here at SOE, like many schools across the world, have an issue with students using AI for academically dishonest reasons. In one of our brainstorming sessions with the lead instructor team, someone made an offhand comment about medical direction being replaced with AI in a dystopian near future.
That gave me a really weird idea. I went to chatgpt.com in a private browser so it wouldn’t recognize me. Here is what I typed into ChatGPT's free version, without an account and without a login:
I'm a paramedic in the back of the ambulance with a patient who can't breathe. I am completely blanking and forgot everything, and I left my radio on scene. Can you help?
Here is our conversation. My responses will be in red.
I’m here. Breathe with me for half a second—you’ve got this. We’ll go simple, muscle-memory ABCs. Don’t overthink. Just do the next right thing.
RIGHT NOW — AIRWAY & BREATHING
1) Position
- Sit them upright if conscious and able.
- If unconscious: supine, head tilt–chin lift (or jaw thrust if trauma).
2) Look / Listen / Feel (10 seconds)
- Chest rise?
- Air movement?
- Gurgling, snoring, silence?
If no effective breathing or very weak → move immediately to BVM.
3) Oxygen
- High-flow O₂ now.
- Breathing but struggling → NRB at 15 L/min
- Not breathing / inadequate → BVM with O₂ at 15 L/min
4) If Bagging
- Good mask seal (two-handed C-E grip if possible)
- Slow it down: 1 breath every 5–6 seconds (adult)
- Watch for chest rise, not force
If chest not rising:
- Reposition head
- Re-seal mask
- Suction if available
5) Airway Adjunct
If they’re not protecting their airway:
- OPA if no gag
- NPA if gag present and no contraindication
6) Suction
- If you hear gurgling / vomit / secretions → suction immediately
- Clear airway, then bag again
7) Think CAUSE (fast)
You don’t need the perfect diagnosis—just life threats:
- Wheezing / asthma / COPD → Albuterol if you have it
- Stridor / allergic reaction → Epinephrine if indicated
- Pink froth / CHF → CPAP if breathing, BVM if not
- Opioids? Pinpoint pupils, slow breathing → Naloxone
- Trauma? Jaw thrust, control bleeding, ventilate
8) If They Deteriorate
- No pulse → CPR
- Pulse but not breathing → BVM + O₂
KEY REMINDERS
- Oxygen + ventilation buys time
- Perfect diagnosis does not matter right now
- Slow, controlled bagging saves lives
- You do this job because you can do this
I’m here with you.
If you can, tell me one thing:
👉 Are they conscious or unconscious right now?
My response: conscious, I think wheezing
ChatGPT:
Good — that helps a LOT. You’re doing fine. Stay with me.
Conscious + Wheezing = Treat the Bronchospasm
1) Position
- Sit them straight up. Let them tripod if they want.
- Do not force them flat.
2) Oxygen
- NRB at 15 L/min right now
(or nasal cannula + neb if that’s your setup)
3) Bronchodilator — NOW
If you have it:
- Albuterol neb (± ipratropium if protocol allows)
- Coach them: slow, deep breaths through the mask
This is the priority intervention.
4) Listen While You Treat
- Expiratory wheeze → asthma/COPD
- Silent chest / minimal air movement → BAD → prepare to assist ventilations
If they’re getting tired:
- Rising RR
- One-word sentences
- Accessory muscle use
- Altered mentation
➡️ Prepare BVM early — don’t wait for them to crash.
5) Consider Epinephrine
If severe distress, poor air movement, or suspected anaphylaxis:
- IM epi per protocol (this can be life-saving)
Clues: hives, swelling, hypotension, sudden onset.
6) CPAP?
If you have CPAP and they can tolerate it:
- Wheezing + increased work of breathing → CPAP can help
- If they panic or can’t keep seal → stop and go back to NRB
7) Reassure Them (this matters)
Calm voice, eye contact:
“You’re getting air. I’m helping your lungs open up. Stay with me.”
Anxiety worsens bronchospasm.
RED FLAGS — ACT FAST
- Wheezing disappears but work of breathing stays high
- Cyanosis
- Decreasing LOC
➡️ Assist ventilations with BVM + O₂
You are doing the right things. Wheezing patients feel terrifying but they are often very treatable.
Tell me:
👉 Are they speaking full sentences, short phrases, or just single words?
My response: couple words
Okay — that’s severe respiratory distress, but you’re still ahead of it. Stay focused. Do this now, in order.
RIGHT NOW
1) Sit them UP
Let them lean forward. Do not lay them back.
2) Oxygen + Bronchodilator
- Neb albuterol NOW (high priority)
- Oxygen driving the neb or NRB at 15 L/min if neb not immediately ready
If the neb is running, keep it running.
3) This is the moment for EPINEPHRINE
If your protocol allows (asthma with severe distress / minimal speech / impending failure):
👉 IM epinephrine now
This can save their airway. Don’t wait for them to crash.
WATCH CLOSELY (next 1–2 minutes)
If you see any of these:
- Speech worsening
- Wheezing getting quieter
- Extreme fatigue
- Altered mental status
➡️ They are failing
IF THEY START TO FAIL
Assist Ventilations
- BVM + O₂
- Slow, gentle breaths
- Don’t overbag (asthma = air trapping)
If they’re conscious but tiring, assist their breaths rather than fully taking over.
DO NOT
- Force them flat
- Delay epi if indicated
- Overbag
TALK TO THEM
Calm, steady voice:
“You’re doing good. I’m helping your breathing. Stay with me.”
This reduces panic and bronchospasm.
You are doing exactly what a solid medic does. This is a high-stress, high-skill moment, and you’re still making good calls.
One more thing — do you have albuterol running yet, and do you have epi available?
At this point, ChatGPT asked me to create a free account to maintain the highest level of logic, and realistically, that couldn’t happen in an ambulance with a struggling patient. So, how did my interaction with an AI “medical director” go?
Well, to be honest, I actually did this experiment twice. The first time, I didn’t mention leaving my radio on the scene. The AI told me to immediately use my radio to contact online medical control, maintain ABCs until I make contact with my medical director, and start transporting immediately. Which is absolutely the correct answer if this were a real emergency! So I handcuffed it and said I didn’t have my radio, and that’s what you saw play out above.
The first thing I noticed was that it told me to stay calm and reassured me. ChatGPT is notoriously friendly, but its usual emoji-filled, fun-loving tone was absent. It recognized that I was panicking and that real harm could result. The first “orders” were basic and appropriate, with enough information to cover a wide range of pathologies. I decided to have a moment of clarity and recognized the patient was wheezing. This seemed to give the AI a lightbulb moment, and it zeroed in on albuterol, reminding me several times to use it.
So what is the relevance of this experiment to EMS education? Quite a bit. This is a thing any of us can do right now with no account, no email address, and no money. And that means our students can do it too. The AI landscape feels very much like the “blank slate” of the early 90s internet. AI is both exciting and terrifying, and both of the biggest limiting factors of the early internet – poor hardware and the lack of monetization – have already been overcome.
Our students know AI exists, and it’s not going away. We don’t have to embrace it, but we do have to learn to work with it. How do we convince students that learning pathophysiology and pharmacology is important when every answer is quite literally in their pocket? And when 5G wireless internet is a reality in 98% of the country.
At SOE, we are fighting fire with fire, and yes, we are aware of the irony there. We are feeding our assignments into AI models and then asking the AI for help redesigning them, so the AI is less useful. We are also putting a very strong emphasis on taking the National Registry exam, because, at least at the time of writing, there isn’t a reliable way to sneak an AI assistant into Pearson Vue. So students must learn to function independently if they have any hope of passing the exam and actually entering the profession.
Finally, the real answer is professional pride. AI is a powerful tool, but there is nothing quite like the experience of being in an emergency situation and knowing what to do and how to do it. The mental and emotional peace of that knowledge is priceless, and ultimately what we strive to instill in our students.
About the author: Dr. Robert Stanley is a third-generation paramedic and lover of EMS research. He completed his master’s in public health with a thesis about EMS injury prevention, and his Doctor of Philosophy with a dissertation about online workforce education.
If you have a specific topic you would like to see covered in a future column, please contact me at rstanley@schoolofems.org.
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