Gary Berkowitz

likes long walks on the heli deck to a turning & burning HEMS machine. Likes pre-hospital POCUS. Opinions are my own, not my employers.

[ParamedProf is at paramedprof.bsky.social @ParamedProf]

Submission to the Paramedicine Board of Australia on the regulation of Advanced Practice Paramedics - including supervised practice requirements, exemptions from meeting a Registration Standard, evidence-based Standards & requirements for endorsement. https://t.co/PJUwHc4FTB

[Jaynit @jaynitx]

In the 1920s, a Stanford psychologist tracked genius children for 50 years.

Malcolm Gladwell breaks down what he discovered:

Rich families → successful. Poor families → failures.

Not average. Failures. Genius-level IQs that produced nothing.

He spent 60 minutes at Microsoft explaining why we're wrong about success:

The psychologist was named Terman. He gave IQ tests to 250,000 California schoolchildren.

He identified the top 0.1%. Kids with IQs of 140 and above.

His hypothesis: these children would become the leaders of academia, industry, and politics.

He tracked them. And tracked them. For decades.

The results split into three groups.

The top 15% achieved real prominence. The middle group had average, moderately successful professional lives.

And the bottom group? By any measure, failures.

The difference wasn't personality. Wasn't habits. Wasn't work ethic.

It was simple: the successful geniuses came from wealthy households. The failures came from poor families.

Poverty is such a powerful constraint that it can reduce a one-in-a-billion brain to a lifetime of worse than mediocrity.

There's a concept called "capitalization rate."

It asks a simple question: what percentage of people who are capable of doing something actually end up doing that thing?

In inner city Memphis, only 1 in 6 kids with athletic scholarships actually go to college.

If our capitalization rate for sports in the inner city is 16%, imagine how low it must be for everything else.

Here's something stranger.

Gladwell read the birth dates of the 2007 Czech Junior Hockey Team:

January 3rd. January 3rd. January 12th. February 8th. February 10th. February 17th. February 20th. February 24th. March 5th. March 10th. March 26th...

11 of the 20 players were born in January, February, or March.

This isn't unique to the Czechs. Every elite hockey team in the world shows the same pattern. Every elite soccer team too.

Why?

The eligibility cutoff for youth leagues is January 1st.

When you're 10 years old, a kid born in January has 10 months of maturity on a kid born in October. That's 3 or 4 inches of height. The difference between clumsy and coordinated.

So we look at a group of 10 year olds, pick the "best" ones, give them special coaching, extra practice, more games.

We think we're identifying talent. We're just identifying the oldest.

Then we give the oldest more opportunities, and 10 years later they really are the best.

Self-fulfilling prophecy.

The capitalization rate for hockey talent born in the second half of the year? Close to zero.

We're leaving half of all potential hockey players on the table because of an arbitrary date on a calendar.

Kids born in the youngest cohort of their school class are 11% less likely to go to college.

11% of human potential squandered because we organize elementary school without reference to biological maturity.

Now here's the part about math.

Asian kids dramatically outperform Western kids in mathematics. The gap is enormous and consistent across decades of testing.

Some people say it's genetic. It's not.

It's attitudinal.

When Asian kids face a math problem, they believe effort will solve it.

When Western kids face a math problem, they believe the answer depends on innate ability they either have or don't.

Here's the proof.

The international math tests include a 120-question survey. It asks about study habits, parental support, attitudes.

It's so long most kids don't finish it.

A researcher named Erling Boe decided to rank countries by what percentage of survey questions their kids completed.

Then he compared it to the ranking of countries by math performance.

The correlation was 0.98.

In the history of social science, there has never been a correlation that high.

If you want to know how good a country is at math, you don't need to ask any math questions. Just make kids sit down and focus on a task for an extended period of time.

If they can do it, they're good at math.

Why do Asian cultures have this attitude?

Gladwell's theory: rice farming.

His European ancestors in medieval England worked about 1,000 hours a year. Dawn to noon, five days a week. Winters off. Lots of holidays.

A peasant in South China or Japan in the same period worked 3,000 hours a year.

Rice farming isn't just harder than wheat farming. It's a completely different relationship with work.

There's a Chinese proverb: "A man who works dawn to dusk 360 days a year will not go hungry."

His English ancestors would have said: "A man who works 175 days a year, dawn to 11, may or may not be hungry."

If your culture does that for a thousand years, it becomes part of your makeup.

When your kids sit down to face a calculus problem, that legacy of persistence translates perfectly.

Now consider distance running.

In Kenya, there are roughly a million schoolboys between 10 and 17 running 10 to 12 miles a day.

In the United States, that number is probably 5,000.

Our capitalization rate for distance running is less than 1%.

Kenya's is probably 95%.

The difference isn't genetic. The difference is what the culture values and where it spends its attention.

Here's the most fascinating finding.

30% of American entrepreneurs have been diagnosed with a profound learning disability.

Richard Branson is dyslexic. Charles Schwab is dyslexic. John Chambers can barely read his own email.

This isn't coincidence. Their entrepreneurialism is a direct function of their disability.

How do you succeed if you can't read or write from early childhood?

You learn to delegate. You become a great oral communicator. You become a problem solver because your entire life is one big problem. You learn to lead.

80% of dyslexic entrepreneurs were captain of a high school sports team. Versus 30% of non-dyslexic entrepreneurs.

By the time they enter the real world, they've spent their whole life practicing the four skills at the core of entrepreneurial success: delegation, oral communication, problem solving, and leadership.

Ask them what role dyslexia played in their success and they don't say it was an obstacle.

They say it's the reason they succeeded.

A disadvantage that became an advantage.

Here's what Gladwell wants you to understand:

When we see differences in success, our default explanation is differences in ability.

We forget how much poverty, stupidity, and attitude constrain what people can become.

We refuse to admit that our own arbitrary rules are leaving talent on the table.

We cling to naive beliefs that our meritocracies are fair.

The capitalization argument is liberating.

It says you don't look at a struggling group and conclude they're incapable. It says problems that look genetic or innate are often just failures of exploitation.

It says we can make a profound difference in how well people turn out.

If we choose to pay attention.

This 60 minute Microsoft talk will teach you more about success than every self-help book you've ever read combined.

Bookmark this & give it an hour today, no matter what.

[Gary Berkowitz @FatamboGary]

@TBS_Zermatt @kat__evans

[TBS Zermatt @TBS_Zermatt]

What does emergency thoracotomy look like with two junior doctors, one nurse, no blood bank, and no ICU? Dr Katya Evans from South Africa on ED thoracotomies in resource-limited settings.

Watch the full talk at https://t.co/kgMvp5o0rB

[Natalie Kruit @nattiejpk]

Extending from the PRECARE study, our latest work looking at the cost effectiveness of prehospital #ecpr delivery @HawkmoonHEMS #ecmo #resuscitation

https://t.co/bJX6L6qHod

[M Velia Antonini @FOAMecmo]

Survival on the clock: rethinking where/ how to deliver ECPR
⏱️ time as the central physiologic determinant
🪂 parachute analogy: system context determines measurable benefit
🩺 in-hospital #ECPR: reliability and constraints
🚑 prehospital/hybrid ECPR: overcoming geography & time
⚖️ population-level impact: survival + organ donation
🔍 ECPR: one of most intensively studied interventions in #resuscitation
🪖 team architecture: lessons from special operations forces
🔮 future directions: precision deployment and #AI #ECMO assisted CPR powerful intervention, capable of rescuing patients from refractory cardiac arrest, but its effectiveness is critically dependent on (unforgiving) temporal constraints. Achieving extracorporeal blood flow ideally within 45' of collapse, before irreversible ischemic injury, requires a tightly organized/high-performing systems. The ultimate objective is not simply to expand access to #ECLS, but to ensure that every eligible patient receives timely reperfusion. @ResusJournal
🔗 https://t.co/mC5niZVX2J

[Gary Berkowitz @FatamboGary]

I present to you the Sorting Hat of emergency services. #HarryPotter

[Trauma Surgery & Acute Care Open (TSACO) @TSACO_AAST]

REBOA = higher mortality (47% vs 36%), more transfusions, longer time to OR. No survival benefit. Check the new study by Hatchimonji et al. https://t.co/RnQGoCdJXI and Jansen's commentary https://t.co/s3qqRcWi6C.

@jhatchmd @dianehaddadmd @pdowzicky @markseamonmd

[Gary Berkowitz @FatamboGary]

Thanks @TeslaAUNZ @Tesla your tyre sealer and mini compressor saved the day after a big nail completely deflated this tyre. It allowed me to safely drive the car to a tyre shop this morning avoiding a tow!

[ED ECMO Project @edecmo]

How do you become a world-class ECPR cannulator? Listen to Charles Bruen of the Minnesota Mobile Resuscitation Consortium tell us how he gained the skills to be a cannulator in arguably the best ECPR program in the world. https://t.co/FBohSiEUbD

[Charles Bruen @CharlesBruen]

Dr Miranda is showing great success in HEMS response for ECPR in the Netherlands. A pioneering clinician-researcher. Follow his work. Waiting the publication on the results of the ON-SCENE Trial. #MNECMOSymposium @MMRCbeat @UCardUMN @LionelLamhaut @DYannopoulos @FOAMecmo

[ParamedProf is at paramedprof.bsky.social @ParamedProf]

@PictonChris @Mark_Butler_MP @RyanPark_Keira @Mon4Kooyong @DavidPocock @rosaliewoodruff @tmakrides @MelissaSweetDr @rbarishansky @Aidan_Baron @NRHAlliance @RuralDoctorsAus @ACRRM @NYCEMSwatch @OcoRory @CumminsNM @DanielRGerard @ShannonFentiman @DelportShannon @LeonBaranowski @Ldn_Ambulance @DrLouReynolds @gphec @NAEMT_ @RosalieBoyce @RuthForrestMLC @GuyBarnett @MaryAnneThomas @mbismark @DuncanMcConnel1 @Bruce_ @jeremyrockliff @RunMedic @PAC_Paramedic @CdnParamedicine @McNallyProject @tracyniks @cmdrbob558 David Ferris highlights the trials, tribulations and treats from the best bad decision you’ll ever make: In defence of working in #EMS as a career #health #EMT #paramedicine https://t.co/EdBNmPaQ3T

[Patrick Georgoff, MD @georgoff]

Another awesome debate from my favorite conference @TCCACS!

Is DIRECT TO OR RESUSCITATION worth it? 👇🏼

[Cliff Reid @cliffreid]

🧵 Want to MASTER hyperangulated videolaryngoscopy?

This 3-step process will transform your (and your team's) first-pass success rate ⬇️
1/5

[@IncrEMentuM @IncrEMentuMconf]

More lessons by @cliffreid at IncrEMentuM 2025:
➡️ Can't intubate, can't oxygenate

When seconds matter and the airway fights back.

[Eddy J. Gutierrez, MD @eddyjoemd]

The decision as to whether we should provide bicarb to our critically ill patient takes places every single day. This paper breaks things down amazingly well. Don’t forget to pay attention to the serum CO2. 🎩 tip to the authors.
https://t.co/wtiQFg1wGN

[Tony Walker ASM @agwalker01]

🚑 Stroke care matters. So does how we deliver it.

A new study shows that patients transported by the Melbourne Mobile Stroke Unit (MSU) had:

✅ 2x better odds of full recovery
✅ ½ the mortality rate at 90–180 days
✅ Higher thrombectomy rates (40% vs. 23%)

But better outcomes came with higher hospital costs (~$17,949 more per patient).

🔑 Key takeaway? Linking ambulance + stroke registry data is crucial to evaluating & improving emergency care. We need more of this!

📖 Read the study: https://t.co/YMFMoNQz85

[James Oswald @JamesOz1]

🚨 New Podcast Episode! 🚨
If you’re uncomfortable talking about death, this podcast is for you.
@expensivecare
🔊https://t.co/j9JcIAW8Mj

[Paramedicine Monash University @monash_para]

We are delighted to announce that the next intake of CARES [Competency Advancement and Refresher Education for Skilled Paramedics] will be MARCH 17TH 2025. For more information, contact Course Facilitator Amanda Taylor-Hall via email or visit the link in bio. 🚑

[Gary Berkowitz @FatamboGary]

@DaveSwart7 I told you to invite me…