My bona fides

I am a pediatrician with fellowship training in Pediatric Critical Care. As a pediatrician I used these methods to help develop a PICU, critical care transport program, Emergency Medical Care bachelor's degree program for paramedics, nurses, and Respiratory Care Practitioners, two pediatric chronic intensive care facilities, and several EMS programs. Currently I am the medical director for REMSA, the Riverside EMS Agency (Riverside County, California) and an Assistant Professor of Pediatrics, Loma Linda University School of Medicine. My publications are listed in the reference section of this blog.

My academic background includes two bachelor’s degrees from the University of California, Irvine, My degrees are in Social Ecology and Biological Science. I was a chemistry major for a while at California State University, Long Beach. My medical degree (1984) is from the University of California, Irvine, where I also did my pediatric residency. My Pediatric Critical Care Fellowship was in Dallas at the Children's Medical Center and Parkland Memorial Hospital.

My ambulance work started in 1972 for a private ambulance company while I worked my way through Cerritos Community College. In 1974 the opportunity came to work as a Rescue Ambulance (RA) Driver for the LAFD which I took as I was having problems affording college. Most of my time was spent assigned to Fire Station 66 in South Los Angeles during the period when the street gangs Crips and Pirus (later called the Bloods) were moving into the area and an Angel Dust epidemic came through. This is where I not only learned what is now called HRO it is where I practiced it and learned refinements I have used later.

On the RA we worked with two men assigned to the RA unit and responded alone. A fire company or the police responded only when we made the request from the scene. There is one exception, if the caller used the word “gun” or said it was a shooting we waited for law enforcement, otherwise we responded alone to all crimes of violence including stabbings. This gave me experience in forming a team on the run while treating a patient and keeping everyone safe. 

My station commander at FS 66, William J. Corr, counseled me to consider medical school. He was my model and mentor for how I would later practice medical care in emergencies and the basis for what is HRO in my use.

While working with the LAFD I took my paramedic training at the Paramedic Training Institute of the University of Southern California under Ronald Stewart, MD. Dr. Stewart was an early pioneer in teaching paramedics using high level concepts such as use of the measures of cardiac output (how much the heart pumps each minute) to understand medical emergencies and guide treatment. He also focused on supporting the paramedics as a means to improve care. He encouraged me to apply to medical school and it is his philosophy of medical care, how to treat patients, and how to work with paramedics that I continue to use today.

The men who taught me during this period were combat veterans from World War II, the Korean Conflict, and the Vietnam War and they were also veterans of major fires, crime scenes, and the Watts Riots. The Central Receiving Hospital ambulance men had been transferred to the LAFD to create the Rescue Ambulance. These men worked in the Central Receiving Hospital Emergency Department with doctors and nurses, and responded to the field where they worked closely with LAPD. They had a wealth of information of both emergency medical care and law enforcement activity.



My mountaineering experience had become a part of my daily life both as belief and metaphor. I began climbing in high school in the Sierra Nevada Mountains both winter and summer climbing and saw my first death in the mountains before I graduated from high school. It was at this death that I began to wonder about decision-making under stress. I have since made solo climbs in winter and have trekked in the Himalaya including an attempt to ascend Mt. Pharchomo in the Rolwaling Himal. I aborted that climb when I developed pulmonary edema below the 20,000 ft. summit and made a solo descent to high camp.