Santa Barbara Paramedic Flips Traditional Patient Assessment on Its Head

The paramedics did almost everything right.

They responded to a call for an unconscious man slumped on a bus bench. He was barely breathing. His pupils were pinpoint. The signs pointed to a narcotics overdose. They administered naloxone. The man woke up.

What they didn’t do — what wasn’t required at the time — was fully expose the patient.

“He was still wearing a sweatshirt,” said Mark Rock, a veteran paramedic and EMS educator. “No exposure, which is now part of the secondary assessment.”

As police stood nearby, the man reached into his waistband, pulled a gun concealed under the sweatshirt, and shot and killed a paramedic. Police returned fire, killing the patient.

“So now we have a dead patient, and we have a dead paramedic, all because they didn’t do that number one step,” Rock said. “Had this been out there then, that paramedic would be alive today, and the patient would be alive today.”

As of January 1, a new paramedic assessment model designed by Rock — called 21st Century Patient Assessment — is now mandated policy for paramedics in Ventura County. Santa Barbara County could follow.

The model, which Rock developed and published in 2019 while teaching at Palomar College in San Diego County, flips traditional patient assessment on its head. Rather than adapting hospital-based clinical protocols for the field, the framework is built specifically for the unpredictable environments paramedics actually work in — homes, roadways, overturned vehicles, and poorly lit spaces.

“Nobody had ever really taken an assessment model and said, ‘Hey, what about what actually happens out there upside down in a car at 3 in the morning?’” Rock said.

Traditional models emphasize airway and breathing before addressing bleeding — a sequence that makes sense in hospitals, where bleeding is usually already controlled. In the field, Rock said, that delay can be fatal.

“So people were bleeding, continuing to bleed severely, and lost so much blood volume that now they’re in irreversible shock,” he said. “And now the patients are gonna die, no matter what you do with their airway or breathing.”

Under the new model, bleeding control and scene safety are prioritized immediately.

“You walk into somebody’s house, you look at the patient, and if you see they’re bleeding, you’re on that immediately,” he said. “You’re not worrying about airway. You’re not fixing breathing. It’s doing nothing until you address that bleeding.”

Rock’s framework was first published in the Journal of Emergency Medical Services in March 2019 and later republished in a European EMS journal. It was slated for presentation at the 2020 European EMS Conference in Glasgow, Scotland, before the event was canceled due to COVID.

Despite national exposure, Rock said the model failed to gain traction because local EMS agencies continued renewing older protocols.

“So about a year and a half ago, I went to our local EMS agency and said, ‘Hey, you guys read the article, you liked the article — why aren’t we changing our protocol to reflect it?’” Rock said.

Ventura County formally adopted the model in September and its implementation began January 1, 2026. According to Rock, because Ventura and Santa Barbara Counties share the same medical director, Dr. Daniel Shepherd, there is potential that S.B. County could adopt the protocol as well. Shepherd has not yet responded to requests for comment. 

Rock went on to emphasize that the model is designed not only to save patients, but also to protect first responders. “Paramedics fairly frequently get killed on duty,” he said. “It’s not unusual for them to get stabbed, or shot, or something else, as a result of the fact that they just simply did not do a good assessment.”

Studies show rates of around 10-15 deaths per 100,000 paramedics, exceeding firefighters. Overall, paramedics face significant risks, with an injury rate over four times the national average.

Scene control — including lighting, bystanders, animals, and potential weapons — is explicitly built into the new framework to limit said risk.

“Make sure there’s no weapons around the patient,” Rock said. “Those kinds of things were never really addressed.”

He said the goal now is to change expectations around response in the field, not just the policy.

“Oftentimes, what winds up changing practices are not policies and laws, but expectations,” Rock said. “It needs to become standard practice to implement an assessment framework in emergency medical services that is specific for the field setting.”