When Guidelines and Recommendations Don’t Match Reality: Where Science Meets Practicality

Guidelines and recommendations provide structure, but they don’t always align with what truly works in the field. Progress in EMS demands leaders who can interpret emerging science, adapt it responsibly, and design protocols that reflect both evidence and operational reality. This session highlights how Palm Beach County Fire Rescue advanced prehospital medicine through Double Sequential External Defibrillation for ventricular fibrillation, prehospital whole blood and plasma programs for trauma and isolated traumatic brain injury, and new approaches to burn resuscitation and sepsis care. Chief Charles Coyle shares lessons learned in building defensible, evidence-informed protocols while maintaining trust and accountability across field providers and hospital partners. The session will review how to navigate the struggles of being progressive within the broader medical community, where innovation can be met with hesitation. Attendees will leave with a leadership framework for balancing science, safety, and system culture—where practicality meets progress.