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It's Your Money: Four-for-Life -

The Four-For-Life program, as amended in 2002, stipulates that four dollars be charged and collected at the time of registration of each passenger vehicle, pickup and panel truck. The funds collected, pursuant to Section 46.2-694, Code of Virginia, shall be used only for emergency medical services. The law further states that the Department of Health shall return twenty-six percent (26%) of the registration fees collected to the locality wherein such vehicle is registered to provide funding for:

(1) Training of volunteer or salaried emergency medical service personnel of licensed, nonprofit emergency medical service agencies; or

(2) for the purchase of necessary equipment and supplies for licensed, nonprofit emergency medical service agencies.


Jurisdictions serve ONLY as the recipient of the money which is to be forwarded to the local agencies. In some areas, the agencies themselves decide how much or how the money is disseminated. In some areas it is equally dived buy the number of agencies  in the  county or city.

Be sure you know how this funding is handled in your jurisdiction because IT’S YOUR MONEY.

BREMS Area Returns:














New! Protocol Changes Training Notes We have had numerous inquiries regarding the training for the new protocol revisions.

Steve is in the process of putting the Instructor Update together to get the new training resources and policies out to the Optional Skills Instructors so they can begin the EZIO and CPAP training. 

Also,  the Intermediate Providers will need an Optional Skills class on Zofran (Optional Med-60) before they can administer it. 

Since Amiodarone is listed as an Essential medication for Intermediates and Paramedics, there is no optional skills class required, however since we are used to using prefilled syringes during codes we would encourage all Intermediates and Paramedics to review the attached sheet regarding mixing and administering Amiodarone, as a code situation is not a good time to have to figure new drug mixing calculations.  Click Here for the Amiodarone Administration Guide.   

The mixing instructions will be fixed in the top of all BREMS drug boxes but the proper syringes and the D5W will have to be located among your supplies in your units.  We would encourage pre-planning and maybe doing some training on this at your agency training meetings.

If you have any questions regarding these meds or the Optional Skills Training please contact Steve Wade, Training Coordinator, at (434) 947-5934.

Early Notification to ER of Cardiac Patients Dr. Fenton and Dr. Peter O'Brien have asked all BREMS agencies and providers to assist with getting the most information possible on our chest pain patients to the hospital so they can be better prepared to move them into the system.

If you are trained by a BREMS optional skills instructor to obtain a 12-Lead EKG, please send the 12-Lead as early as possible. Also, please call the hospital via cell phone or other phone with the patient's name (MedCom is 434.947.3211. This will assist in obtaining the patient's previous medical records and allow the hospital staff to be better prepared prior to your arrival.


iGel Airway Release

As of June 1st, 2019 the BREMS Region will begin using the iGel Airway in place of the KING LTD Airway. 

The i-gel® is the innovative second generation supraglottic airway device

from Intersurgical. The first major development since the laryngeal mask

airway, i-gel has changed the face of airway management and is now widely

used in anesthesia and resuscitation across the globe.

Made from a medical grade thermoplastic elastomer, i-gel has been designed

to create a non-inflatable, anatomical seal of the pharyngeal, laryngeal

and perilaryngeal structures whilst avoiding compression trauma. Launched

in 2007 after years of extensive research and development, i-gel now has

an established reputation in anesthesia with three adult and four

pediatric sizes in the range, ideal for use with patient weights between

2-90+kg. In 2012, the indications for use were expanded to include use as

a conduit for intubation (with fiberoptic guidance).

Training & Procedure Information:

icon iGel Training Powerpoint

icon iGel Procedure Protocol

icon iGel Trainer Kit