Code 321 Podcast

Courtney Newman flips the script and interviews Nick on one of EMS leadership’s hardest skills: communication. They unpack trust, timing, feedback, conflict, gossip, written versus verbal conversations, and how strong teams handle hard moments with clarity, curiosity, and kindness, without losing sight of culture, relationships, or the patient at the center.

Nick Carson and Prescott Nadeau discuss why mistakes happen in emergency services and how learning from them, through humility, training, and strong systems, makes teams safer and more effective on the street and on the fireground

A deep dive into Into Thin Air by Jon Krakauer, as Nick and Medical Director of Precision, Dr. Chance Sullivan, unpack the 1996 Everest disaster, exploring altitude physiology, human behavior, decision-making traps, and the striking parallels between mountaineering and high-risk work in EMS, fire, and flight medicine. Link to Book: https://www.amazon.com/Into-Thin-Air-Personal-Disaster/dp/0385494785

Prescott Nadeau talks with Drew Clymer about what really happens in backcountry rescue: soaring call volumes, seasonal patterns, technical litter carries, and a high-stakes Camel’s Hump search. Drew Clymer is the Vermont State Search and Rescue Coordinator and the Deputy Chief of Stowe Mountain Rescue. 

Everyone remembers their first time on stage: sweaty palms, shaky slides, and the voice in your head saying, “You’re not ready.” In this episode, Nick, Prescott, and David Weiss talk honestly about conquering stage fright, connecting with audiences, and using conferences to grow as providers and educators. It’s equal parts encouragement and practical advice for anyone ready to step into the spotlight. 

Nick and Prescott sit down with special guest Chris Smetana to tackle one of the toughest topics in fire and EMS: how to recruit, retain, and reinvigorate the workforce. From cadet programs and early training to leadership accountability and burnout, they break down why providers leave, what keeps them engaged, and how culture and mentorship make all the difference. https://www.jems.com/ems-management/nobody-wants-to-work-anymore/

Nick Carson and Prescott Nadeau reflect on their journeys through Fire and EMS, including what they’ve learned, what they’d do differently, and the advice they wish they had heard earlier. From rookie mistakes to the power of mentorship, this episode offers honest insights into life in the fire service and how it shapes the people who serve.

When the mechanism is high and the vitals don’t match, what do you do next? In this episode of Code 321, Nick and Prescott sit down with flight paramedic Stew Hall to talk real trauma. Bleeding you can't see, curveball patients who "look fine," and why good BLS can make or break the golden hour. From the back roads of Vermont to the back of the aircraft, this is trauma care right of boom. 

This month, Prescott is joined by his twin brother, Major Will Nadeau of the U.S. Marine Corps. They dive into the shared values of the military and fire service — tradition, discipline, and the relentless pursuit of excellence. From clean trucks to combat readiness, this powerful episode explores why the little things matter and how holding the line on standards builds elite teams.

Nick and Prescott sit down with longtime friends and fellow firefighters Dave, Whitney, and Eddie for an honest, funny, and heartfelt chat about life in the fire service. From rookie stories to firehouse culture and leadership lessons, they reflect on what brought them to the job—and what keeps them coming back. It’s all about the people, the kitchen table, and the moments that matter.

Steve Petit is a Deputy Chief of Administration for the City of Burlington Fire Department in Vermont. He has over 20 years of experience in the fire service in various levels of leadership. Steve has also served in EMS and Technical rescue capacities with a special passion for teaching Rope Rescue Operations. This episode, Nick and Prescott talk with Steve about how you can get yourself ready to receive feedback. Explore why it goes so wrong and what we can learn about ourselves to better respond to those around us. You can find the book "Thanks for the Feedback" by Douglas Stone and Sheila Heen on Amazon. 

Dr. Chance Sullivan joins Nick and Prescott to talk medicine in the mountains this month. Chance is an attending ER physician in Colorado just outside Denver. Before medical school, he worked as a backcountry guide in Yellowstone and Grand Teton National Park. He has spent two summers as an expedition physician in Alaska for the Juneau Icefields Research Program and also spent a season working at the high-altitude medical clinic in Argentina on Aconcagua, the highest peak outside the Himalayas. Chance is also the Co-Owner and Physician Medical Director of Precision, LLC. 

Welcome back to Season 5! After almost 5 years of the show, Code 321 officially has a new co-host. Prescott Nadeau, a long-time friend of the show and host of his own Life, Fire, Layout podcast, joins our team to discuss all things morale. Nick and Prescott talk about what makes employees happy and what both sides of the chief's desk can do to make the organization thrive. 

Eryn Hart is a high-risk Maternal-Fetal Medicine Surgeon at Crowell Health West in Grand Rapids, Michigan. Before working as a doctor, she served as a 911 provider at the EMT, AEMT, and Paramedic levels. She has completed a residency in Obstetrics/Gynecology and a fellowship in Maternal-Fetal medicine. Eryn also serves in the United States Navy Reserve as a Maternal-Fetal physician. This episode explores the world of caring for high-risk pregnant women and their babies. 

Courtney Tomaino is a state-level administrator and a current NREMT Paramedic. She has served in volunteer and paid EMS services in capacities ranging from CPR-certified driver to crew chief paramedic while raising a family with young kids in Vermont. She is involved in training, education, clinical practice, and administration centered around EMS providers. This episode is the second in the Lessons in Leadership series and dives deep into the work-life balance discussion many services face today. Courtney joins the show to share some common workplace dynamics seen in the modern EMS workforce with a few creative solutions to reinvigorate overwhelmed staff. 

This episode of the show dives into ten common pitfalls in treating a sick hypothermia patient with a brief look into the rationale behind it. From equipment to cellular metabolism, this episode will help identify and prevent the common problems with this atypical patient. Below are the references to read through the source documents for this content.  AHA Part 10.4: Hypothermia www.circulationaha.org DOI:10.1161/CIRCULATIONAHA.105.166566 Rischall ML, Rowland-Fisher A. Evidence-Based Management Of Accidental Hypothermia In The Emergency Department. Emerg Med Pract. 2016 Jan;18(1):1-18; quiz 18-9. Epub 2016 Jan 1. PMID: 26655247. 

This special sneak peek is a selection from Precision’s national conference talks on training program methodology. Everyone wins when the training programs work, so where does it go wrong? This episode will dive into the fundamental structure of a training program and why students succeed. Did you know Precision offers consultation for training program design? Everything from writing a full curriculum to tutoring struggling students. Check out all Precision has to offer at www.precisiontrainingusa.com   Risk Management: www.gordongraham.com  

This episode is for the techies. Artificial Intelligence isn’t just for Science Fiction anymore. The technology is here and rapidly moving into the healthcare field. This episode breaks down the types of AI, how it learns, and how it is being used in the healthcare system so far. How do you feel about AI in the healthcare system? Visit www.precisiontrainingusa.com to connect and share your thoughts.

Critical Care Nurse Riley Hoke joins the show to share the nitty gritty about DKA pathophysiology, identification, and management. Riley has worked as a 911 Advanced EMT, a Medical Intensive Care Unit (MICU) Nurse, and a flight nurse for the UVM Health Network transport team. This episode will dive into the complex pathophysiology of DKA and how treatment is much more than just lowering the blood glucose level.

This episode of the Code 321 Podcast features Colleen Githens, a flight-certified respiratory therapist with 14 years of experience in emergency respiratory care. Colleen has served all patient populations as an RT including as a member of the critical care flight team. Colleen shares tips about how to approach sick pediatric patients and how to prepare for the kids in distress.

Emergency Medicine Toxicology Doctor Joe Kennedy joins the show to share about how he approaches a patient who might be suffering from a toxicology emergency. From mushrooms to grandma’s medication, it’s his job to figure out what chemicals are causing the issue and correct them. Did you know the poison control hotline has an option for medical providers? Give them a call next time you encounter a toxicology case in the field (1-800-222-1222), you might hear Dr. Joe Kennedy on the line!

This month's episode is for the nerds. Dive deep into cardiac physiology, pharmacology, and invasive hemodynamics of a critical care patient. Have you ever wondered what critical care transport patients are like? Have your Google machine and a hot cup of coffee ready. Remember, anatomy, physiology, and pathophysiology are the building blocks of great patient care. Special thanks to Dr. Doug George and Megan Papineau for their assistance on this one. 

Derek Gavelis is a seasoned outdoor adventurer and current firefighter. Derek shares how years of high-risk adventure sports like rock climbing, ice climbing, mountaineering, and kayaking have taught him life lessons he applies to his career in emergency services. Derek shares how adrenaline seekers share parallels with those responding to emergencies. 

Kyle Blake is a Lieutenant assigned to Engine 1 in Downtown Burlington, Vermont, and is the Recruit Academy Lead Instructor for new firefighters in the department. Kyle is responsible for developing the next generation joining the department ranks with a novel approach to entry-level firefighter training. Today’s episode is the first in a new series from the Code 321 Podcast called “Lessons in Leadership”. Kyle shares how experiences in his own life have helped develop his strategy for leading fire companies, recruits, and fellow firefighters.

David Weiss is a Critical Care Flight Nurse (CFRN) who serves on the Vermont State Urban Search and Rescue (USAR) Team. As a nurse, David works full-time in a Level 1 Trauma Center Emergency Department and with the UVM HealthNet Transport Critical Care HEMS Program. He started his EMS career at 16, working on various EMS agencies in the Northeast. David holds specialty care certifications in Critical Care, Pediatrics, Emergency Medicine, and trauma care. This episode dives into how the USAR members prepare and deploy to large-scale incidents across the nation. 

Part 2 of The Opiate Problem discusses potential solutions such as Safe Injection Sites (SIS), Community Response Teams (CRTs), Methadone, Suboxone and Buprenorphine use (Carroll, 2020). This month’s Code 321 Podcast will feature a two-part series with Patrick Crowley of vtdigger.org. Patrick and I worked at the Burlington Fire Department together as Firefighter/EMS providers. Patrick is now a reporter with vtdigger.org and joins me to discuss his two-part article series entitled “The Third Wave” (links below).   Carroll GG, Wasserman DD, Shah AA, Salzman MS, Baston KE, Rohrbach RA, Jones IL, Haroz R. Buprenorphine Field Initiation of ReScue Treatment by […]

This month’s Code 321 Podcast will feature a two-part series with Patrick Crowley of vtdigger.org. Patrick and I worked at the Burlington Fire Department together as Firefighter/EMS providers. Patrick is now a reporter with vtdigger.org and joins me to discuss his two-part article series entitled “The Third Wave” (links below). Part one of this series will explore how opiates have become such a problem and why our communities are fighting an uphill battle with this deadly epidemic. Part 2 of The Opiate Problem will be released on December 15th.  Other media used from WCAX via: https://www.wcax.com/2023/09/08/burlington-authorities-respond-rash-overdoses Ng J, Sutherland C, Kolber […]

This episode of the Code 321 Podcast takes a deep dive into Ketamine. Since the creation of the drug in the 1960s, it has been a staple of the medical community for a wide variety of treatments. Learn about the history of this medication, how it works, why it is loved (or hated) and what is coming next in the world of Ketamine use. The article used in the creation of this podcast is “Use of Ketamine During Procedural Sedation” by Tonya Jolly and Heather McLean of Duke University Medical Center (citation below). Thanks to YT for the idea for […]

United States Air Force Pararescue Jumper Paul Barendregt joins us from Alaska to talk about his 25-year career in the Special Operations Community as an PJ. Paul has conducted missions on all 5 continents with multiple combat deployments. Paul is also the owner of PJB Solutions, LLC offering leadership and medicine in the operational environment. Today’s episode we learn a little bit about the USAF PJs and what they do to save lives. 

Northeast Emergency Training Solutions, LLC owners Nick Carson and Tim Ferris share some brief thoughts on the EMS World Expo Conference live from New Orleans, Louisiana. NETS was selected as a Pre-Conference workshop for our “Hardening the Target: Preparing Your Community for the Active Threat”. Make sure to check out “Life Fire Layout” on Apple Podcasts. Prescott Nadeau (who is a reoccurring guest on Code 321) interviews Nick Carson on the recent NETS TACMED full scale exercise. https://podcasts.apple.com/us/podcast/life-fire-layout/id1700669359?i=1000628694365

Join us this month to discuss 5 lessons learned from the critical care orientation process. Set yourself up for success by practicing the fundamentals and prioritizing responsibilities in the correct order. The lessons we will discuss in this episode are:

Today’s episode features Corey Souza, a current firefighter/paramedic. We talk about Atul Gawande’s book, Being Mortal: Medicine and What Matters in the End. We should be viewing our patients’ experiences through their eyes, learning what their priorities are and respecting their wishes. The medical provider can help facilitate the life our patients want with every contact. Listen now to learn how the lessons learned from this book could affect your practice. 

On this episode of the Code 321 Podcast, Nick dives deep into the 2023 Summer NAEMT Newsletter. Specifically, the article found on page 10, Tips for Creating a Culture of Workforce Engagement (NAEMT, 2023). Listen to the episode and check out the links to learn more! Make sure to leave us a review on Apple […]

Today’s episode features our Director of Operations, Kyle Brouliette as we discuss the purpose and design behind our Active Threat Response programs. Unfortunately , these events have become common place and we need to be prepared to address the loss of life. In this episode, learn why and how we have developed our training programs […]

In this episode of the show, Rebecca shares her experiences as a DCF supervisor and investigator while giving tips to providers. It is not just the scary photos in the back of the textbook, let’s dive in and discuss what the DCF does and the role of an EMS provider in the system built to […]

Welcome back listeners! As the podcast host, it felt important to give the listeners a quick update as to why we needed a little break from the show. Thank you for the support and we look forward to releasing new episodes monthly! Make sure to give us a good rating on Apple and Spotify if […]

Can you visualize what is happening inside of the body when you are treating your patients? Do you know what it is supposed to look like, how it is supposed to operate, and what you need to do to fix it? This episode features. Captain/Paramedic John Christman as we discuss how students can apply their […]

This episode was taken from our 2022 Fall CAPCE Paramedic Refresher. We welcome back Prescott Nadeau to the show as we listen to his lecture on Mass Casualty Incident Command for the EMS provider. Prescott Nadeau is a Captain and Training officer at the Williston, VT Fire Department. He has been in the fire service […]

Dave Cohen is a former mountain bike racer and current NREMT Paramedic. Dave is one of a few paramedics who provide medical event coverage for elite mountain bike races. Some of his recent race locations include British Colombia, New Zealand, Mexico, Nepal among others. Dave shares his experience on what Wilderness Medicine on a Enduro […]

*Warning* The content of this episode can be upsetting to listeners. Please use discretion.  A lecture from our archives back in February of 2022: Detective Nicki Moyer is an expert in Domestic Violence and is one of the leading investigators in the area. Nicki will talk briefly about what EMS should know, what domestic violence […]

Vermont EMS joins me to talk about the biggest retention issue they found during a large study of Vermont EMS providers: toxic workplaces and psychological safety. Learn what some of the big issues are, and the vision the State has to tackle them. Beth Brouard is the EMS data Manager for Vermont EMS. Beth is currently […]

Chris McCarthy is the EMS Program Manager for Northeast Emergency Training Solutions, LLC. With her 20 years of experience as an EMS educator, Instructor Coordinator and National Registry Representative, she will discuss the new portfolio competency program that will be replacing the psychomotor testing for EMT testing. Interested to hear more? Tune in to see how […]

Sarah Schlein is the Physician Medical Director for Northeast Emergency Training Solutions, LLC. She is an Emergency Medicine attending physician at the University of Vermont Medical Center, Associate Professor at the Larner College of Medicine and Wilderness Medicine director in Burlington, VT. She founded and directed the medical school and Emergency Medicine residency Wilderness Medicine program and is […]

Today’s episode dives into the role of Isotonic Crystalloids and the delicate balance during a trauma resuscitation. Dan Eng joins the show to give his take on the chemistry behind the different fluids we might see in the field and the fundamentals that we should be thinking while making clinical decisions in the field with […]

Dan Batsie is the Director of the Division of Emergency Preparedness Response & Injury Prevention for the State of Vermont. He has worked as a paramedic in busy urban systems such as Syracuse, NY and Portland, Maine. Dan also has extensive experience as an educator across New England. Today’s episode discusses the concept of managing emotions in a response to stress. Dan shares his tips for overcoming these situations and introduces the concept of stress inoculation training. 

Andy Speier (brother to Matt Speier, featured on episode #23) is a Battalion Chief and technical rescue specialist currently working in Washington State. His career has included over 40 years of service as a medical provider, technical rescue operator, firefighter across the United States and overseas in Israel. Andy is an original member of Peak Rescue and current coordinator of the Special Operations Rescue Team (SORT) in his county-based system. Andy has worked in Midtown Manhattan as a member of FDNY on Engine 54 and Ladder 4. He is also a Technical Rescue Contributing Editor for FireRescue Magazine. 

Emergency Department Pharmacist Catherine Platt joins the show today to discuss Epinephrine including some ways we use it as EMTs, AEMTs and Paramedics. We also will break down three different clinical trials that have shaped how we administer the drug leading to best practices in and out of the hospital. The studies used in this show are listed below for your reference.  Simons, F. Estelle R., and Xiaochen Gu. “Epinephrine Absorption in Adults: Intramuscular versus Subcutaneous Injection.” www.jacionline.org/Article, J ALLERGY CLIN IMMUNOL, 5 Aug. 2001, www.jacionline.org/article/S0091-6749(98)701903/fulltext.  Perkins, Gavin D., et al. “A Randomized Trial of Epinephrine in out-of-Hospital Cardiac Arrest: Nejm.” New England Journal of Medicine, 23 Aug. 2018, www.nejm.org/doi/full/10.1056/NEJMoa1806842#article_references.  Cole, J. B., Knack, S. K., Karl, E. R., Horton, G. B., Satpathy, R., & Driver, B. E. (2019). Human Errors and Adverse Hemodynamic Events Related to “Push Dose Pressors” in the Emergency Department. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 15(4), 276–286. https://doi.org/10.1007/s13181-019-00716-z

Today’s episode features Bill Elwell, a 36-year fire service veteran who specializes in trauma informed peer support and crisis intervention. Bill has an associate degree in Fire Science, he is a certified Chaplain and holds a certificate in Critical Incident Stress Management. Talking about what Moral Injury is, Bill shares his personal experiences and discusses why he chose to spend his life in the mission of helping those who suffer trauma. His LLC, First Responder Core Wellness provides education as well as support to those in public safety and public health. Bill’s website is www.unbrokencord.com. 

Luke Jackson is a Vermont native who has 17 years of experience working both in and outside of the hospital system as a critical care medical provider. Luke started his career as a Firefighter/EMT right here in Vermont and is currently a Critical Care Flight Paramedic for Lifeflight of Maine as well as an ICU Nurse in Central Maine. If you’re interested in progressing to the next level, don’t rule anything out. Luke will share his experience about how sometimes making the leap to the next level can open more doors to a future you might not see from your current perspective. 

This episode of the Code 321 Podcast features Chance Sullivan, Nick Alsofrom, and Noah Rohrer who are all second year Emergency Medicine Residents at the University of Vermont Medical Center Level I Trauma Center. During this roundtable, we will talk about what experiences they have had through their medical training and they give their tips on how to succeed if you’re interested in pursuing the big bad M.D. Degree.