Bryan Fleischman
High Acuity. Low Resources. Real-World Medicine.
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Bryan Fleischman is a residency-trained, board-certified Physician Associate (PA) practicing emergency medicine in a rural critical access hospital in New Hampshire while also serving as a firefighter-paramedic. His background includes high-volume 911 response and critical care transport in New York City and Long Island during the COVID-19 pandemic. He has additional experience in outpatient and mobile anesthesiology, with a focus on advanced airway management, particularly in pediatric patients. Bryan serves as an Adjunct Assistant Professor at the Emory University School of Medicine and mentors MD and PA students through the Emory Farmworker Project in rural South Georgia, delivering medical care to underserved communities with extremely limited access to healthcare. He remains actively involved in EMS education as an ALS preceptor and regularly lectures within his fire department and at state and national EMS, Wildland EMS, and PA conferences.
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Area of Expertise
Venom and Vitals: Managing Bites and Stings
Bites and stings are common prehospital encounters, but the severity and speed of envenomation are often underestimated. This session provides a practical, field-focused approach to recognizing and managing venomous exposures, including snakes, spiders, insects, and marine life. Drawing on wilderness medicine principles and real-world experience, participants will learn to identify early signs of systemic toxicity, apply evidence-based management, and avoid common pitfalls that worsen outcomes. Emphasis is placed on decision-making in rural and delayed-access environments, where definitive care and antivenom may be hours away.
The Long Ride: Managing Critical Patients During Prolonged Transport
In rural EMS systems, transport is often the most critical phase of care, with definitive treatment an hour or more away. This session focuses on managing critically ill and injured patients during prolonged transport, where early decisions, reassessment, and anticipating deterioration are essential. Drawing from real-world rural EMS and critical access experience, participants will learn practical strategies for ventilation, hemodynamic support, packaging and positioning, and recognizing early signs of decline. Through case-based discussion, this talk equips providers to maintain stability and make high-stakes decisions when help is far away.
Skill Dilution: Why We're All Trained—But Not Experienced
The EMS workforce has grown by over 30% in the last decade, with more clinicians trained in advanced skills than ever before. However, opportunities to perform high-acuity interventions have not increased at the same rate.
As advanced airway alternatives and expanded capabilities across systems reduce the frequency of procedures like endotracheal intubation, these critical skills are performed less often and distributed across a larger group of clinicians. Additionally, training disruptions during the COVID-19 pandemic further limited hands-on clinical experience for many learners.
The result is skill dilution: EMTs and paramedics who are trained and credentialed, but with fewer real-world repetitions when it matters most. This session explores the impact of skill dilution on performance and outlines practical strategies to improve readiness for high-risk, low-frequency events.
Rhabdo in the Wild: Heat, Crush, and High-Impact Emergencies
Rhabdomyolysis is not just a laboratory diagnosis—it is a clinical problem that develops in the field, often in patients exposed to heat, exertion, or crush injury. In high-acuity, low-resource environments, clinicians must recognize early warning signs and act before confirmatory data is available. This lecture focuses on the practical recognition, pathophysiology, and management of rhabdomyolysis in real-world settings, emphasizing early fluid resuscitation, complication prevention, and transport decision-making. The goal is simple: identify the problem early, intervene aggressively, and prevent the downstream complications that actually kill these patients.
High Acuity, Low Resources: The Rural Emergency Reality
Rural emergency medicine demands a different mindset—patients are just as sick, but resources, personnel, and access to definitive care are limited. This session explores the high-stakes reality of managing critically ill and injured patients in rural and critical access settings, where early decisions carry significant consequences. Drawing from real-world EMS and emergency department experience, participants will learn practical strategies for prioritization, airway and resuscitation management, and anticipating deterioration during prolonged transport. Through case-based discussion, this talk emphasizes operational decision-making and the critical role of EMS and emergency departments functioning as a unified system when help may be hours away.
From Mild to Mayday: When Allergic Reactions Turn Critical
Allergic reactions can rapidly evolve from seemingly minor symptoms into life-threatening airway compromise and distributive shock. This lecture explores the recognition and management of severe allergic reactions and anaphylaxis in the prehospital and emergency setting, emphasizing the importance of early identification and decisive intervention. Through case-based discussion and operational scenarios, participants will examine airway assessment, pharmacologic management, epinephrine administration, and resuscitation priorities in rapidly deteriorating patients. Special focus is placed on the pharmacology of commonly utilized medications such as epinephrine, antihistamines, corticosteroids, bronchodilators, and adjunctive therapies, with discussion centered on evidence-based practice, timing of intervention, and common misconceptions in allergic emergencies. Attendees will leave with practical strategies to recognize, treat, and stabilize critically ill allergy patients in both routine and resource-limited environments.
From Heat Stroke to Hypothermic Arrest
Temperature-related emergencies are often subtle, easily missed, and rapidly fatal without early recognition and intervention. This session delivers a high-yield, field-focused approach to identifying and managing both hypothermia and hyperthermia in prehospital and austere environments. Participants will learn to recognize early warning signs, differentiate severity, and apply targeted management strategies using available resources. Key concepts—including cardiac instability in hypothermia, heat stroke pathophysiology, and critical complications such as rhabdomyolysis—are reinforced through practical, scenario-based decision-making. Designed for EMS and wilderness providers, this talk emphasizes real-world strategies to stabilize patients and prevent deterioration when time, environment, and resources are working against you.
Don't Miss This: High-Risk, Low-Frequency Emergencies
This case-based session focuses on the dangerous diagnoses hiding behind common emergency department complaints. Patients with chest pain, back pain, headache, and abdominal pain often present with reassuring vital signs, normal initial testing, and plausible benign explanations. These features contribute to diagnostic error through anchoring, premature closure, and diagnostic momentum. Using real-world cases, this lecture highlights subtle clinical cues that should prompt reconsideration of the working diagnosis and outlines practical strategies to recognize high-risk conditions early, avoid cognitive traps, and initiate timely management in both resource-rich and austere environments.
Broken and Alone: Wilderness Trauma Essentials
This session provides a practical, evidence-informed approach to trauma assessment and stabilization in remote or resource-limited environments. Participants will learn to rapidly identify life-threatening injuries, manage common traumatic presentations with limited equipment, and adapt standard trauma principles to wilderness and austere settings. The session emphasizes improvisation, environmental considerations, and decision-making when definitive care may be hours away. Realistic field scenarios and case-based discussion will help learners build confidence in managing fractures, dislocations, soft-tissue injuries, and multi-system trauma when “you are the only help for miles.”
Austere Airway: Managing the Impossible
Airway management in EMS is often reflexive - secure the tube, control the airway. In austere and resource-limited environments, that reflex can do more harm than good. This lecture challenges traditional airway dogma and reframes airway decisions around environment, resources, and patient physiology rather than just procedural skill. Through high-risk, field-based scenarios, participants will explore when airway intervention helps and when it harms, with a focus on high-performance BVM ventilation, supraglottic airways as practical definitive tools, and early recognition of the truly failing airway. Built for "high acuity, low resources" settings, this session delivers practical, street-ready strategies that translate directly to the next shift.
Too Hot to Handle: Heat Illness in Remote Environments
Heat-related emergencies are increasingly common and extend far beyond wilderness treks. Patients collapse at athletic events, construction sites, firegrounds, disaster shelters, rural farms, and city sidewalks when heat overwhelms human physiology. This session reviews the recognition and management of heat illness, from mild exhaustion to life-threatening heat stroke, in both resource-rich and resource-limited contexts. Case-driven teaching and evidence-based cooling strategies will equip participants with the skills to intervene effectively, decide when rapid evacuation is essential, and prevent further morbidity. Attendees will leave with actionable tools to manage heat illness wherever it strikes — whether in a crowded stadium, a sweltering fire scene, or a remote hiking trail.
Out of the Blue: Managing Lightning Emergencies
Lightning strikes are sudden, unpredictable, and potentially devastating. This session equips providers with the knowledge and confidence to manage lightning-related injuries across diverse environments — from mountain ridges and open fields to urban neighborhoods, athletic events, disaster zones, and even the frontline of fire and rescue operations. Participants will learn how to recognize unique injury patterns, prioritize scene safety under continuing storm hazards, and treat life-threatening complications such as cardiac arrest, respiratory failure, and neurologic deficits. Through case-based examples and evidence-based strategies, this session highlights practical interventions that improve survival when a bolt out of the blue turns a routine call into a high-stakes emergency.
Chilled to the Bone: Hypothermia in the Field
Cold-weather emergencies are among the most challenging situations for providers, and hypothermia is not confined to the backcountry. Patients can be found in urban alleyways, vehicle crashes, flood disasters, mountain trails, or even post-rescue settings where cold exposure becomes life-threatening. This session focuses on recognition, pathophysiology, and management of hypothermia across these diverse environments. Through case-based discussion and evidence-driven strategies, participants will learn to assess severity, initiate appropriate rewarming, and prevent further heat loss when resources are limited. Attendees will leave with a practical framework to improve outcomes for patients who are cold, vulnerable, and critically ill — no matter the setting.
Nowhere to Go: Essentials of Prolonged Patient Field Care
What happens when evacuation is delayed, transport is unavailable, or resources are hours away? This session covers the essentials of prolonged patient field care, where providers must stabilize, monitor, and manage patients beyond the usual EMS timeline. Using case-driven discussion and real-world examples, participants will learn practical strategies for prioritizing interventions, improvising with limited resources, and making evacuation decisions under pressure. Attendees will leave with a structured, evidence-based framework to improve outcomes in austere, rural, or resource-limited environments.
Control the Bleed, Master the Wound
From roadside trauma to remote rescues, bleeding control in the field can make the difference between life and death. This fast-paced, practical session is built for EMS professionals, remote care providers, and tactical responders operating in unpredictable environments. We’ll break down the latest in prehospital wound care, including proven irrigation techniques, advanced hemostatic agents like chitosan, kaolin, and hydrogels, and field-tested closure methods—sutures, staples, adhesives, and bioactive dressings like medical-grade honey. You’ll also learn when (and how) to use local anesthetics, start antibiotics, and decide between primary and delayed closure. The MARCH algorithm will guide our triage approach. Walk away with tools, techniques, and confidence to manage complex wounds when time, resources, and backup are in short supply.
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