Loud & Clear: EMS Guiding Principles - Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers

The mechanism behind agricultural emergencies can completely change the risk to both the patient and the responders arriving to help. Ross talks with Jessica Wilburn, Agromedicine Nurse Coordinator, and Maggie Denning, Outreach Coordinator with the North Carolina Agromedicine Institute, about the injuries and environmental hazards first responders may encounter in agricultural communities. They cover tractor rollovers, livestock injuries, pesticide and fumigant exposure, grain-bin entrapment, hydraulic injection injuries, and machinery involving augers and power takeoff shafts. The conversation also covers responder safety, including how to recognize when machinery is still energized, why a barn or greenhouse call may involve dangerous chemical exposure, and how local farmers can sometimes be one of your best sources of information. In this episode, you’ll learn: Why farmers often minimize injuries, and why “minor” complaints deserve a closer look Why grain bins and manure lagoons can create secondary victims when rescuers enter How a tiny hydraulic-fluid puncture wound can threaten an entire extremity despite looking benign at first What a first responder should do first when approaching moving farm machinery   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. North Carolina Agromedicine Institute Guests: Jessica Wilburn, Agromedicine Nurse Coordinator, North Carolina Agromedicine Institute Maggie Denning, CNA and Outreach Coordinator, North Carolina Agromedicine Institute

The First 60 Seconds After ROSC: How To Prevent Re-Arrest How do you improve your resuscitation systems beyond the ACLS algorithm? Will talks with Ian Blanchard, Senior Scientist for Alberta’s provincial EMS system about the “frame of survival” and why rehearsing equipment placement and vector change can make critical actions nearly automatic when the call comes in. Then, Ross talks with Mike Humphrey of Lethbridge Fire and Emergency Services about what happened when his team reviewed their cardiac arrests and discovered a recurring pattern: post-ROSC hypotension followed by a near 50% re-arrest rate. Their response was to redesign post-ROSC care around the first 60 seconds to prevent life-sustaining therapies from disappearing during the transition of care. In this episode, you’ll learn: What “doing reps in the clinical gym” looks like when you don’t have access to a high-fidelity simulator Why moving a cardiac-arrest patient too early can undermine CPR quality and make resuscitation worse What 1 minute blood pressure reassessments can reveal that a single “good” post-ROSC pressure may miss Why a vasopressor-dependent patient should stay on the EMS stretcher  The best time to prepare for vector change, pit-crew roles, and post-ROSC care   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Canadian Resuscitation Outcomes Consortium Resuscitation Academy International Liaison Committee on Resuscitation Episode 133: Post-ROSC Care & Pacing: Prove the Perfusion Guests: Ian Blanchard, former paramedic and Senior Scientist for Alberta’s provincial EMS system Mike Humphrey, Lethbridge Fire and Emergency Services

Getting a pulse back feels like a win. Seeing pacer spikes and something that resembles a pulse feels reassuring. But in both situations, the monitor can make you feel better before the patient actually is. Geoff Murphy of Master Your Medics breaks down the fragile minutes after return of spontaneous circulation. He explains why hypotension deserves immediate attention, how falling end-tidal CO2 can warn that cardiac output is deteriorating, and when fluids can serve as a short bridge to vasopressors. Then, paramedic Jacob Miller challenges some of the assumptions clinicians learn about transcutaneous pacing. He discusses pad placement, pacing current, ultrasound, pharmacologic support, and why clinicians need to keep reassessing even after they think they have capture. In this episode, you’ll learn: Why an initially normal blood pressure after ROSC can be falsely reassuring How skeletal muscle contraction during pacing can create ECG artifact and a false sense of mechanical capture What can improve your chances of capturing a patient when transcutaneous pacing is needed Why practicing the pacer during routine monitor checks can make a rare, high-stress call much easier to manage Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Interested in ABLS Now? Our listeners get 10% off with code LOUD26POD. Jacob’s Resources: Article with images of false vs true electrical capture: Kimbrell J, Kreinbrook J, Poke D, et al. False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehosp Emerg Care. 2024;28(7):928-936. doi: 10.1080/10903127.2024.2321287   Link to Scott Weingart's EMCrit podcast episode discussing false positive SpO2 signal without actual capture:  https://emcrit.org/emcrit/tcp-pulse-ox-fail/   Jacobs website with handout version of my slides:  https://jacobmilleracnp.com/slides/   Guests: Geoff Murphy, Founder and Lead Educator of Master Your Medics Jacob Miller, paramedic, flight nurse, critical care nurse, nurse practitioner, and DNP

Burn patients can create a disproportionate amount of anxiety. The calls are uncommon, the injuries can be visually overwhelming, and it is easy to get distracted by the burn itself. Ross and Will talk with Mark Johnston, a longtime Advanced Burn Life Support instructor and burn program leader at Regions Hospital, about simplifying prehospital burn care. Mark explains how most burn patients should be approached and why you need to resist the urge to make wound care the first priority. They also dig into the findings that should make you truly concerned about an inhalation injury, how to estimate total body surface area, and which smaller burns still warrant burn-center evaluation. In this episode, you’ll learn: Which airway findings increase concern for inhalation injury Why the simple 125/250/500 mL-per-hour approach can be more useful in the field than calculating a full Parkland formula How mechanism changes your priorities in thermal, chemical, electrical, and enclosed-space burns How wet dressings and aggressive wound care can increase heat loss or distract clinicians from early interventions   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August. The Emergency Mind: Wiring Your Brain for Performance Under Pressure, by Dan Dworkis, MD PhD Peak Performance Under Pressure, by Stephen Hearns Episode 109: Understanding the EMS Power Curve Guests: Mark Johnston, BSN, RN, TCRN, Burn Program Manager at Regions Hospital

Readiness is about more than knowing the medicine. It’s about creating the conditions for patients, families, and clinicians to feel safer and more capable when the situation is unfamiliar, overwhelming, or high risk. First up, Boston MedFlight flight nurse Nicole King discusses neurodivergence, sensory overload, and how traditional EMS behaviors can unintentionally escalate distress. She explains why slowing down, reducing stimuli, and involving caregivers can completely change the experience for patients who are struggling. Then, Ross talks with pediatric flight nurse and Blakery Content creator Christopher Blake about pediatric readiness and why confidence on low-frequency, high-risk calls has to be built before the tones drop. They discuss pediatric emergency care coordinators, agency-wide readiness, and using QA/QI. In this episode, you’ll learn: How to recognize when behavior may be the result of sensory overload or difficulty processing the environment Why pictograms, fidget toys, headphones, sunglasses, and weighted pressure can reduce escalation  How a Pediatric Emergency Care Coordinator can help an agency identify gaps Why family-centered communication can reduce fear and improve cooperation How to adapt your assessment when a patient cannot tolerate standard vital-sign monitoring    Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August.   Pediatric Readiness Assessment KultureCity Ben’s Blue Bags and Carter Kits Emergency Medical Services for Children Innovation & Improvement Center Birth Vibes: Stories & Strategies for An Empowered Birth, by Jen Hamilton Guests: Nicole King, flight nurse, Boston MedFlight Christopher Blake, pediatric flight nurse and creator of Blakery Content

What differentiates heat stroke from heat exhaustion? Once central nervous system dysfunction appears, every minute spent at an elevated core temperature increases the risk of permanent neurologic injury or death. Ross and Will talk with emergency physician and wilderness medicine specialist Dr. Greg Doctor about the full spectrum of heat-related illness – from heat cramps, rash, and edema to syncope, exhaustion, and life-threatening heat stroke. They discuss how to avoid anchoring on the heat when a patient loses consciousness and what the critical dividing line between heat exhaustion and heat stroke is. They also examine exercise-associated hyponatremia, drug-related hyperthermia, fluid selection, and the patients who may remain at risk even after they initially appear to recover. In this episode, you’ll learn: How to distinguish heat syncope, heat exhaustion, and heat stroke Why central nervous system dysfunction and an elevated core temperature matter most How to choose between cold-water immersion, continuous water and fanning, ice sheets, and ice-water slurry techniques When transport should be delayed for on-scene cooling, and when cooling should continue   Resources: Wilderness Medical Society Clinical Practice Guidelines for the Prevention & Treatment of Heat Illness: 2024 Update Unlocking Syncope with Matt Mendes The Critical Care of the Sick Runner: A Comprehensive Guide with Dr. Whitney Barrett Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August. Guests: Dr. Greg Doctor, emergency physician and wilderness medicine specialist

Most people picture a master clinician as the person in the room who knows every answer. In reality, mastery looks like the opposite, and admitting what you do not know. Ross talks with FlightBridgeED co-founder Eric Bauer about the “rage to mastery”, the advice that kept him in EMS after a series of difficult calls nearly drove him away, why expertise is perishable, and how ego creates resistance to learning. Then, Will speaks to Master Your Medics founder Geoff Murphy about a medication error that changed how Geoff understood team culture. They explore what happened, and why psychological safety does not lower the standard.   In this episode, you’ll learn: Why sustainable learning habits are more valuable than ambitious goals How experienced clinicians can model vulnerability without undermining their credibility What to look for in a mentor who will challenge blind spots  How to turn an uncomfortable call into action-oriented preparation for the next patient   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August. Guests: Eric Bauer, CEO and Co-Founder of FlightBridgeED Geoff Murphy, Founder and Lead Educator of Master Your Medics

The calls that scare clinicians the most are often the ones they have the fewest opportunities to practice. So what happens during a rare, high consequence emergency? First, Jennifer Barnhart of Austin-Travis County EMS and Sergeant Luke Serrato of the Austin Police Department discuss the response to a mass casualty shooting on Austin’s Sixth Street. Then, Ross talks with Allen Wolfe about three unusual burn and blast-injury cases. They discuss when a smaller burn may still warrant transfer to a burn center, how to recognize an airway that may require an early surgical approach, what a blast mechanism can reveal about hidden injuries, and why protecting burned tissue cannot come at the expense of protecting the airway. In this episode, you’ll learn: How shared language and closed-loop communication help EMS and law enforcement move together  Why responders may need to pass ambulatory or vocal patients to reach those who cannot self-rescue What disrupted tympanic membranes, clothing patterns, circumferential facial burns can reveal   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off and a chance to win a free subscription. Enter before August 1, 2026.   Guests: Jennifer Barnhart, Clinical Specialist, Austin-Travis County EMS Sergeant Luke Serrato, Austin Police Department Allen Wolfe, Senior Director of Clinical Education and Clinical Nurse Specialist at Life Link III

The hardest part of evidence-based medicine is not finding a paper. It is deciding whether that paper should change what you do on your next shift. First, we talk with Dr. Jeff Jarvis about how to evaluate medical literature beyond the headline, abstract, conclusion, or p-value. You’ll hear about the PICO framework and why patient-oriented outcomes should matter more than the numbers that are easiest to measure. Then, Ross talks with emergency physician Dr. Ben Abo about the evidence surrounding rigid cervical collars. He also shares how his EMS system removed collars from its ambulances by involving trauma surgeons, neurosurgeons, emergency clinicians, and frontline providers in the change. In this episode, you’ll learn: How to use population, intervention or exposure, comparison, and outcome to decide whether a study applies to the patients you actually treat Why return of spontaneous circulation, p-values, and national benchmarks can distract clinicians from the outcomes patients care about most What the literature suggests about cervical collars, spinal cord perfusion, airway compromise, aspiration risk, intracranial pressure, and pressure injuries How to bring research to a medical director and change a long-standing protocol    Resources: NAEMSP Trauma Compendium: Prehospital Management of Spinal Cord Injuries Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off and a chance to win a free subscription. Enter before August 1, 2026.   Guests: Dr. Jeff Jarvis, MD, MS, EMT-P Dr. Ben Abo, DO, EMT-P Guest Host: Matt Hedlun, Battalion Chief of Education at Thompson Valley EMS

Trust is the architecture behind every patient interaction you run. Dr. Cory Scheer, author of Closing the Trust Gap, has identified three evidence-based building blocks of trust: competency, problem-solving, and care for others. It turns out EMS providers already use all three the moment they step on scene. In this episode, we unpack the gap between senior leaders and frontline EMS workers, what your "trust signature" reveals about how you naturally lead, and why imposter syndrome might be a signal worth listening to instead of pushing through. Book a Free Coaching Call · Sign up for the weekly newsletter ·  Check out The Loud & Clear Fellowship program.

The hardest part of a bad call is rarely the algorithm. In two different interviews I explore some human traps of running an EMS call. I talk with Danny and Rance from DNR Prehospital Education about a choking arrest, a difficult field intubation, and the trainer-trainee dynamic that made the call more complicated than the procedure itself. Then Bobby breaks down the CAFE pneumonic of heuristic traps: commitment, acceptance, familiarity, and expert halo. This episode moves from the protocol and algorithm to the human challenges of running. Want more? Sign up for our weekly newsletter The Confidence Dispatch Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off and a chance to win a free subscription (giveaway on July 1st, 2026). 

A postpartum patient does not need to look dramatic to be in real danger. In this episode from FAST 26, Ross talks with Amy Loucks about pregnancy-related deaths, maternal care deserts, postpartum warning signs, hypertension, cardiomyopathy, infection, and the calls EMS can easily miss. Then Elizabeth Garchar walks through amniotic fluid embolism, now often framed as an anaphylactoid reaction of pregnancy: sudden cardiovascular collapse, right heart failure, DIC, TXA, whole blood, AOK, and the principle that matters most when everything goes bad: treat mom first.   Interested in the Loud & Clear Fellowship? Sign up for a free coaching call to learn more.    Sign up for a weekly newsletter The Confidence Dispatch for EMS performance tips delivered straight to your inbox.    Episode Resources- CDC: Preventing pregnancy-related deaths — https://www.cdc.gov/maternal-mortality/preventing-pregnancy-related-deaths/index.html Amniotic fluid embolism overview — https://my.clevelandclinic.org/health/diseases/15463-amniotic-fluid-embolism AOK regimen for amniotic fluid embolism — https://pmc.ncbi.nlm.nih.gov/articles/PMC9477128/   https://www.marchofdimes.org/peristats/ https://www.marchofdimes.org/research/maternity-care-deserts-report.aspx  https://saferbirth.org/  https://www.nmperinatalcollaborative.com/  

Pre-Oxygenation is not just putting oxygen on the patient and hoping the sat buys you enough time. In this episode, Ross talks with Scott Weingart after his FAST26 talk on preventing peri-intubation arrest. They get into why many peri-intubation arrests are predictable and preventable, why shunt physiology requires pressure and not just FiO2, and how EMS clinicians can build a field-ready setup with a nasal cannula, BVM mask, PEEP valve, and continuous pressure. Scott also walks through low-, moderate-, and high-risk patients, why high-risk oxygenation patients may not be good RSI candidates, and what changes for asthma, aspiration risk, and morbid obesity. Book a FREE Coaching Call with Us Here Learn More About the Loud & Clear Fellowship American Burn Association ABLS Now giveaway and 10% listener discount PREOXI trial: Noninvasive Ventilation for Preoxygenation during Emergency Intubation PreVent trial: Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults EMS World Live + FAST 26 conference coverage Guest: Scott Weingart / EMCrit — https://emcrit.org/

A checklist should reduce cognitive load. So why does yours make things worse? Airline pilot and safety officer Glenn Fisher breaks down how aviation refined checklists over decades of crash data and human factors research — from verification-only flows to abnormal read-and-do procedures to defining the criteria for what should actually earn a spot on the card. Want more? Book a Free Coaching Call at emspodcast.com/free-coaching-call Sign up for the weekly newsletter at empodcast.com/newsletter NASA papers on checklist design- Human Factors of Flight-Deck Checklists: The Normal Checklist COCKPIT CHECKLISTS: CONCEPTS, DESIGN, AND USE Design Guidance for Emergency and Abnormal Checklists in Aviation   American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Pediatric sepsis is easy to miss because the first hour often looks ordinary. Kids compensate, until they don't. In this episode, Will Berry talks with Dr. Peter Antevy about the case that still bothers him and why fluids, vasopressors, antibiotics, and hospital feedback all have to be treated as one resuscitation system. Book a Free Coaching Call with us at emspodcast.com/free-coaching-call Sign up for our weekly newsletter The Confidence Dispatch at emspodcast.com/newsletter  American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Most EMS skills training creates an illusion of competence. You drill a procedure, check a box, and move on. But what does the research actually show about competency and retention? Dr. Jason Hine (EM physician, SimKit founder) breaks down the actual science of procedural skill acquisition: S-curves, encoding and consolidation, retrieval practice, and why expensive simulation labs often underperform cheap, high-rep lo-fi tools. Plus: a big announcement about SimKit and The Loud & Clear Fellowship. Book a Free Coaching Call at emspodcast.com/free-coaching-call Sign up for the weekly newsletter at emspodcast.com/newsletter   SimKit - https://simkit.co Made to Stick - https://amzn.to/4d5B5qA American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Stephanie Suzadail's favorite word is "fail." She'll tell you why and how we should embrace it. In this episode she walks through the difference between failure that builds you and failure that breaks you. Why Sisyphus is a warning, not a role model. Why the best clinicians you'll ever work with have made bigger mistakes than you have. Why high-functioning organizations report mistakes ten times more often than average ones. Why self-identified perfectionists only ever climb to "moderately successful."  Book Your Free Coaching Call at emspodcast.com/free-coaching-call Sign up for the weekly newsletter - emspodcast.com/newsletter  American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Most medics walk onto a domestic violence scene armed with instinct and not much else. Jim Schmidt thought 20 years in the fire service had prepared him for anything — until he had to identify his stepdaughter Gabby Petito's body in 2021. In the months and years after he realized how little EMS is prepared to recognize and treat domestic violence victims. What he's learned since has rewritten what first responders should be doing on these calls. Jim walks us through the red flags, why strangulation may leave no external marks but signals a 750% jump in homicide risk, how to document, how to treat and talk to the patient, and what patterns we can recognize. Resources DomesticShelters.org — find local DV/SA orgs by address National DV Hotline — 1-800-799-SAFE · text START to 88788 JEMS article by Jim Schmidt on educating first responders to recognize domestic violence: https://www.jems.com/ems-training/domestic-violence-educating-first-responders/  Jim Hopper, PHD on the neurobiology of trauma and sexual assault: https://www.youtube.com/@JimHopperPhD  Want to go deeper? Book a Free Coaching Call at emspodcast.com/free-coaching-call Sign up for the weekly newsletter: emspodcast.com/newsletter   American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Don't Be A Field Training Officer Be A Field Training Mentor. Field training is about more than teaching skills, it shapes culture, standards, and the kind of clinician someone becomes. In this episode, Ross sits down with Ben Tacy onsite at FASTCAN to talk about the origins of field training and why Ben prefers the language of mentorship over “field training officer”. If you care about leadership, education, workplace culture, or building better medics, this conversation is worth your time. If you want deeper discussions on topics just like this subscribe to our weekly newsletter - emspodcast.com/newsletter  Want some individualized mentorship? Book a free coaching call with us - emspodcast.com/free-coaching-call  Interested in The Loud & Clear Fellowship? Book a free coaching call with us: emspodcast.com/free-coaching-call American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Frostbite is more dangerous than it looks and easier to make worse than you think. In this episode, Ross and Will sit down with Dr. Greg Doctor, a wilderness medicine specialist and emergency physician practicing in the Colorado Rockies, to break down frostbite from the prehospital perspective. Greg walks through field assessment, when to rewarm vs. when to leave it alone, pain management, and when to bypass your local ED for a tertiary care center. Whether you’re running urban calls or wilderness rescues, you may see this and this episode will help inform how you approach cold injury.   Want more? Subscribe to The Confidence Dispatch, our free weekly newsletter for paramedics who want to get 1% better every shift: →  https://loudandclear.kit.com/d45b012fae   Want to go even further? The Loud & Clear Fellowship is a year-long course and coaching community for new medics who want to close the gap between what school taught them and what the job actually demands. Not a lecture series. Not another CE you'll forget by your next shift. Real frameworks for clinical reasoning and mental performance. The stuff nobody teaches you in school. If that sounds like what you've been looking for, book a free 30-minute coaching call and we'll talk about whether it's the right fit. Even if it’s not we’ll give you actionable advice on the call so that you still walk away with something valuable: →  emspodcast.com/free-coaching-call American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

The contaminated airway is one of the most unforgiving calls in prehospital medicine. Blood, vomit, debris — your laryngoscope goes in and you're blind. For decades, paramedics managed this with tools designed for a clean OR and training that never got close to the real thing. Dr. Jim DuCanto decided that was unacceptable. He's the anesthesiologist who invented the DuCanto catheter and SALAD (Suction Assisted Laryngoscopy and Airway Decontamination). Will Berry sat down with Dr. DuCanto at the FASTCAN conference for a conversation. In this episode we cover: - The SALAD technique, step by step - Why paramedic OR training should default to video laryngoscopy - The downsides of SALAD that Dr. DuCanto himself will tell you about - What a new portable suction device does differently Guest: Dr. Jim DuCanto anesthesiologist, inventor of the DuCanto catheter and the SALAD technique   Want more? Also subscribe to The Confidence Dispatch — Our free weekly newsletter for paramedics who want to get 1% better every shift: → https://loudandclear.kit.com/d45b012fae   Want to go even further? The Loud & Clear Fellowship is a year-long course and coaching community for medics who want to close the gap between what school taught them and what the job actually demands.  Not a lecture series. Not another CE you'll forget by your next shift. Real frameworks for clinical reasoning and mental performance — the stuff nobody teaches you in school. If that sounds like what you've been looking for, book a free 30-minute call and we'll talk about whether it's the right fit: → emspodcast.com/free-coaching-call American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

What if the mistake wasn't your fault... but it's still your responsibility? That's the tension Shay Montgomery sits with every time she talks about the day she flew to a scene without the drug bag. Shay is a flight nurse and educator. At FAST 25, she gave one of the sharpest talks of the conference — not on a procedure or a drug, but on the science of why humans make mistakes and what we can actually do about it. WHAT YOU'LL LEARN: Task Brackets — Your brain bundles repetitive actions into smooth automated sequences. The First Habit Rule — The first habit is permanently ingrained. Old habits lurk underneath new ones and surface under stress. Get it right the first time. Goal-Oriented Stimulus — Don't ask "Do I have everything?" Ask "Where are the things I need?" and physically point to them. The Preceptor Problem — Most preceptors feel unprepared. The goal isn't to make "mini me", it's to create independent critical thinkers. Shift Fatigue — Cognitive function degrades meaningfully at 16 hours. Just Culture — Human error is inevitable. Punishment doesn't fix the system. The guilty already feel terrible. They need peer support and system redesign.   RESOURCES: Join The Loud & Clear Fellowship    CONNECT WITH US: - Instagram- @emsloudandclear - YouTube- https://www.youtube.com/@EMSLoudandClear - Website- www.emspodcast.com    CONNECT WITH SHEA: - TikTok: @flightnurseshay - Instagram: @flightnurseshay Interested in The Loud & Clear Fellowship? Book a free coaching call with us: emspodcast.com/free-coaching-call American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Miss your first intubation attempt and your patient's risk of adverse events jumps sevenfold. By the third attempt? Nearly guaranteed complications. This isn't about your anatomical knowledge or practice hours—expert clinicians fail too. David Olvera, who led national research on intubation checklists, reveals why your brain predictably fails under pressure and what systems actually prevent it. You'll learn the challenge-response checklist protocol that speeds up your intubation time (not slows it down), the HEAVEN criteria's six specific warning signs that predict difficult airways before you attempt, and why dump kits create muscle memory that works in the dark. David shares the story that started his human factors obsession and proves that expertise doesn't protect you from error—systems do. This is operational excellence: building checklists that think for you when tunnel vision sets in.   Want more? Also subscribe to The Confidence Dispatch — Our free weekly newsletter for paramedics who want to get 1% better every shift: → https://loudandclear.kit.com/d45b012fae Want to go even further? The Loud & Clear Fellowship is a year-long course and coaching community for new medics who want to close the gap between what school taught them and what the job actually demands. Built by an ER doc who runs medical direction for 5 rural Colorado agencies and has talked with hundreds of paramedics about exactly where that gap shows up. Not a lecture series. Not another CE you'll forget by your next shift. Real frameworks for clinical reasoning and mental performance — the stuff nobody teaches you in school. If that sounds like what you've been looking for, book a free 30-minute call and we'll talk about whether it's the right fit: → emspodcast.com/free-coaching-call Resources   The Loud & Clear Fellowship - emspodcast.com/program  To see the actual checklist - https://www.airmedandrescue.com/latest/long-read/medical-insight-latest-tools-ensure-successful-first-pass-intubation    Guest/Cast/Crew information- Guest- David Olvera Host- Ross Orpet, Will Berry    Catch up with us after the show - Instagram- @emsloudandclear - YouTube- https://www.youtube.com/@EMSLoudandClear - Website- www.emspodcast.com   Books we recommend - The Dichotomy of Leadership - https://amzn.to/4fiCAjN - Extreme Ownership - https://amzn.to/3O1FWfa -  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf - Thinking Fast and Slow - https://amzn.to/4fiJG85   Gear We Like - Good Stethoscope - https://amzn.to/3YJJrf2 - Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  - Notepad for taking notes on calls - https://amzn.to/3Z1X21J American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Behind the curve. We've all heard it. Most of us have lived it. That sinking feeling when you're mentally three steps behind where the call actually is. The concept of the Power Curve comes from aviation—pilots need to understand the phases of flight and how the plane will react differently and require different inputs during each of these phases. The same principle applies to your 911 calls. This episode breaks down the exact framework to chunk calls into five critical phases. When you understand phases you understand what is needed during each point of the call and how to stay ahead. How to build if-then statements that eliminate decision fatigue. The psychological safety that lets you reset after screwing up in the apartment. And why 80% of medical errors tie back to the one phase—the hospital handoff. Stop reverting to chaos. Build the system that keeps you ahead. Guest/Cast/Crew information- Guest- Moose and Josh from Alert Medic 1 podcast Host- Ross Orpet, Will Berry  Catch up with us after the show - Instagram- @emsloudandclear  YouTube- https://www.youtube.com/@EMSLoudandClear   Website- www.emspodcast.com   Books we recommend - The Dichotomy of Leadership - https://amzn.to/4fiCAjN - Extreme Ownership - https://amzn.to/3O1FWfa -  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf - Thinking Fast and Slow - https://amzn.to/4fiJG85 Gear We Like - Good Stethoscope - https://amzn.to/3YJJrf2 - Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn    - Notepad for taking notes on calls - https://amzn.to/3Z1X21J    Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our bi-weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

You're not making mistakes because you're dumb. You're making mistakes because of seven predictable factors—and once you know them, you can control them. Kris Kaull delivered a masterclass at FASTCAN on the hidden forces that cause even experienced paramedics to miss critical information when it matters most. This isn't about memorizing more protocols—it's about understanding the cognitive science behind high-stakes decision-making in emergency medicine.   Guest/Cast/Crew information- Guest- Kris Kaull, FP-C Host- Ross Orpet Catch up with us after the show - Instagram- @emsloudandclear  YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Books we recommend - The Dichotomy of Leadership - https://amzn.to/4fiCAjN - Extreme Ownership - https://amzn.to/3O1FWfa -  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf - Thinking Fast and Slow - https://amzn.to/4fiJG85 Gear We Like - Good Stethoscope - https://amzn.to/3YJJrf2 - Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn   - Notepad for taking notes on calls - https://amzn.to/3Z1X21J    Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

This episode tells the tragic story of Max McKenzie, a teenager with asthma who died from anaphylaxis despite receiving "standard care." His death led his father, Dr. Ben McKenzie, to develop the AMAX4 algorithm. Educator and critical care transport nurse/paramedic Bruce Hoffman breaks down the algorithm and explains why the combination of anaphylaxis and asthma can be lethal, why IM epinephrine may not be enough, and why this is the time to be aggressive. But this isn't simply about memorizing another algorithm. It's about developing the operational confidence to recognize when standard approaches may fail and override your impulse to "try the book answer one more time." You'll learn to identify time-critical scenarios, build red-flag combination awareness, and make high-stakes decisions without second-guessing yourself.  Want to systematically build this decision-making confidence? Discover The Loud & Clear Fellowship at emspodcast.com/program —where we teach the operational skills your school didn't.   Guest/Cast/Crew information- Guest- Bruce Hoffman, Associate Professor, Critical Care RN and Paramedic Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Books we recommend The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J   Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Struggling to remember every protocol in high-pressure medical situations? You're not alone—and memorizing everything isn't the answer.   Join us for this game-changing conversation with Jean Francois Couture, co-founder of Parys Medical, as we unpack the science of habit formation for EMS and healthcare providers. Recorded live at FAST 25, Jean breaks down the "habit loop" (cue, routine, reward) and introduces the concept of the "meta-habit"—a habit of habits that transforms how you access critical information during emergencies.   Learn why the best clinicians don't memorize everything but know exactly where to find what they need when seconds count. Discover practical strategies for mental simulation, protocol familiarization, and building muscle memory with your cheat sheets. Jean shares actionable steps including planning your clinical scenarios, scheduling regular practice sessions, and developing unconscious competence through repetition.   Whether you're new to EMS or a seasoned veteran, this episode provides a roadmap for achieving clinical excellence through deliberate practice and smart information management.   Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

What happens when a 24-year-old woman is found frozen in a tree well after last being seen 8 hours prior, with a core temperature of 62°F (17°C)? In this extraordinary case, paramedic Miles Randell and his team performed 4 hours of CPR in knee-deep snow on April Fool's Day 2014—and she walked away with zero neurological deficits. This wasn't luck. Miles breaks down the critical decision to defy transport protocols and how they managed a failed field intubation when her torso sank into the snow during compressions. The case became a catalyst for building Teaam Aeromedical, a progressive nonprofit wilderness air ambulance saves time, lives, and healthcare dollars. Learn the physiology of hypothermic cardiac arrest, why less intervention is sometimes more, and how to package patients in snow to prevent further heat loss. Whether you work in wilderness medicine or urban EMS, the principles here apply: know the science, challenge protocols when they don't serve your patient, and get them to the right place at the right time. Interested in The Loud & Clear Fellowship course? Check us out at - emspodcast.com Guest/Cast/Crew information- Guest- Miles Randell, Paramedic, Founder of TEAAM Aeromedical, for more go to teaam.ca  Host- Ross Orpet   Catch up with us after the show - Instagram- @emsloudandclear - YouTube- https://www.youtube.com/@EMSLoudandClear - Website- www.emspodcast.com   Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our bi-weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

What do you do when the anatomy you've memorized simply doesn't exist anymore? When a patient's entire face is gone, and your standard airway management tools won't work? This is where training meets reality. Critical care transport legend Allen Wolfe joins us to dissect a real case, a conscious patient with a self-inflicted shotgun wound—no mandible, no nose, no midface—just open tissue and blood spraying everywhere. This conversation covers the Lefort facial injury classification, why the cervical collar is often more harmful than helpful in penetrating trauma, delayed sequence intubation techniques, and intubating in atypical positions. Allen also explains cerebral perfusion pressure through the Monroe-Kelley hypothesis, and why hypotension can be devastating in traumatic brain injury. But beyond the technical skills, this episode is about leadership under pressure, verbalizing your thought process to your team, and having backup plans A through Z before you need them. It's about deliberate practice and mental simulation so you don't freeze when chaos hits. Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae   Guest/Cast/Crew information- Guest- Allen Wolfe, CFRN Host- Ross Orpet, MD   Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Discover the difference between resistance (your daily shield built through sleep, nutrition, relationships, and spiritual wellness) and resilience (the anaerobic sprint you can't maintain forever).    Recorded on-site at Fast25, James Boomhower, founder of StayFit4Duty, breaks down why the EMS culture of "pushing through" is fundamentally flawed. Using the metaphor of muscle training, he explains that continuing to stress a system without recovery doesn't build strength—it causes injury. The recovery time from a torn mental health muscle is exponentially longer than if you'd simply rested appropriately.    With over 20 years in New England EMS including training to become a licensed mental health counselor, James brings a perspective that's desperately needed in emergency medicine. He provides the missing manual for sustainable careers in emergency medicine. In this episode he discusses why the 5 pillars of resilience should really be the 5 pillars of resistance. He shares vulnerable stories from his own journey, including the colleague who grabbed him by the collar to stop him from burning out while helping others, and even some relationship strategies to prevent your worst shift from destroying your home life.   Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae   Resources Learn more about StayFit4Duty and connect with James on instagram at @stay_fit4duty on Instagram Get The Relationship Action Plan Document  Supplemental Blog post for this episode   Guest/Cast/Crew information- Guest- James Boomhower, LMHC-A, MS, FP-C, NR-P, C- NPT, CCISM Host- Ross Orpet, Will Berry    Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Ever cried in the ambulance because you felt completely overwhelmed? Sophie Fuller has—and she's done something powerful with that experience. In this raw discussion, the Life and Sirens podcast host shares her most vulnerable stories about impostor syndrome, burnout, and finding your way as a new paramedic.   Sophie's path to EMS started in the most unexpected way—from a 39-day hospitalization that included being intubated over the holidays to signing up for EMT school from her hospital bed. But becoming a paramedic brought new challenges: crushing self-doubt, constant anxiety before shifts, and the fear that everyone would discover she was a "fraud." Sound familiar? You're not alone. This conversation dives deep into the psychological struggles that plague EMS providers, especially new medics who lose their support structure after paramedic school.   Learn the difference between destructive doubt and healthy doubt, discover cognitive reframing techniques to combat catastrophizing and black-and-white thinking, and understand why bravery means doing things scared. Sophie emphasizes one crucial truth: you cannot fight impostor syndrome alone. So hit play and let’s do this together.    **If you're struggling with confidence as a new paramedic, The Loud & Clear Fellowship Course can help. To learn more, reach out via email at [email protected] or through our contact page at emspodcast.com or via DM on IG @emsloudandclear**   Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae     Guest/Cast/Crew information- Guest- Sophie Fuller, EMS, HEMS  Host- Ross Orpet   Catch up with us after the show  Instagram- @emsloudandclear  YouTube- https://www.youtube.com/@EMSLoudandClear  Website- www.emspodcast.com American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Death is the Bottom: Why EMS Must Rethink Opioid Use Disorder Treatment   "Nobody told me that the bottom had a basement and the basement had a trap door." This powerful quote from a grieving mother reveals the tragic reality: for patients with opioid use disorder, rock bottom isn't recovery—it's death.   Dr. Jason Hoppe, a medical toxicologist from the University of Colorado, joins us to challenge how EMS providers think about opioid overdoses. The one-year mortality rate after an overdose requiring Narcan? A staggering 6-7%—worse than the one-year mortality after a STEMI. Yet we invest far less in these patients than cardiac emergencies.   This episode covers the evidence-based treatments that actually work (methadone and buprenorphine have incredibly low numbers-needed-to-treat to save a life), how EMS can initiate life-saving treatment in the field, and why "tough love" and waiting for patients to "hit rock bottom" is a dangerous myth. Learn how just an extra 6-minutes on scene could save lives, why patients on buprenorphine need MORE pain medication during trauma, and how breaking the stigma starts with you.   Ready to make a real difference? Discover how EMS providers are uniquely positioned to interrupt the deadly cycle of opioid use disorder.   Want to build unshakeable confidence on scene? We have developed a program to help paramedics go from self-doubt and imposter syndrome to calm competent providers others look to in crisis. If you want to learn more about The Loud & Clear Fellowship course reach out via email at [email protected] or through our contact page at emspodcast.com or via DM on IG @emsloudandclear    Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae   Guest/Cast/Crew information- Guest- Jason Hoppe, D.O.   Hosts - Ross Orpet, Will Berry    Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

What do you do when the blood pressure monitor shows a number you don’t like? Most providers hit the button again—but what if it’s real? In this episode, we’re joined by critical care transport specialist James Boomhower from Boston MedFlight, recorded live at the FASTCAN conference in Calgary, to break down modern vasopressor management.   We explore how norepinephrine replaced dopamine as the first-line vasopressor, the evidence behind those changes, and what to do when your patient is on three drips and the pressure still won’t budge. James shares practical, real-world insights from the space between the ED and ICU, where seconds matter and protocols are stress-tested in real time.   Key takeaways include: when to trust your BP reading and act, how to choose and sequence pressors based on evidence and logistics, why norepinephrine reduces arrhythmias and improves outcomes, and when to add adjuncts like steroids, sodium bicarb, or methylene blue. We also explore hidden factors like ventilator settings and underlying causes that can sabotage even the best pharmacology.   Want to build unshakeable confidence on scene? We have developed a program to help paramedics go from self-doubt and imposter syndrome to calm competent providers others look to in crisis. If you want to learn more about The Loud & Clear Fellowship course reach out via email at [email protected] or through our contact page at emspodcast.com or via DM on IG @emsloudandclear    Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our bi-weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae     Guest/Cast/Crew information- Guest- James Boomhower, LMHC-A, FP-C https://www.stayfit4duty.org/    Host- Ross Orpet   Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Why do some paramedics stay unshakable under pressure while others crumble on the exact same call? The answer isn't about years of experience—it's about understanding the neuroscience of stress and having the right mental tools.   Cody Winterford delivers an incredible breakdown of the five psychological "circles of hell" that providers face in high-stress situations. Starting with the amygdala hijack that triggers your fight-or-flight response, through the crisis of confidence that makes you question everything you've trained for, to analysis paralysis where you're drowning in information but can't make a decision—each level has specific warning signs and proven techniques to overcome it.   We explore why mental simulation is so effective and why elite athletes and the blue angels rely on it to perform at their peak. We discuss tactical breathing techniques, the power of self-talk and focus phrases (even inappropriate ones!), and how to recognize when life distractions are creating "brain fog" that prevents you from accessing your clinical knowledge.   This isn't theory—it's practical, field-tested mental performance strategies adapted from military and elite athletic training, specifically applied to EMS providers. If you've ever felt overwhelmed on scene, doubted your abilities during a critical call, or watched a partner struggle mentally, this episode provides the framework to understand and overcome those challenges.   Want to build unshakeable confidence on scene? We have developed a program to help paramedics go from self-doubt and imposter syndrome to calm competent providers others look to in crisis. If you want to learn more about The Loud & Clear Fellowship course reach out via email at [email protected] or through our contact page at emspodcast.com or via DM on IG @emsloudandclear    Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae     Episode Blog Post- The 5 Levels of EMS Mental Breakdown and How to Escape Them   Guest/Cast/Crew information- Guest- Cody Winniford, EMT-P, CCP-P, FP-C @ordinary_ops_medic @alertmedic1   Host- Ross Orpet, Will Berry    Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

What if the evidence hierarchy you learned in school is incomplete? Dr. Eddie Lang, who helped develop the GRADE system now used by WHO and major resuscitation councils, explains why clinical practice guidelines—not RCTs or meta-analyses—should guide your practice decisions.   Join us at FASTCAN 25 as Dr. Lang, who's helped shap guidelines for the World Health Oganization (WHO) and the International Liaison Committee on Resuscitation (ILCOR), dismantles common misconceptions about evidence-based medicine and explains how it has evolved over the years. It's no longer "whatever the study says"—it's now carefully evaluating research limitations, considering patient values, and assessing feasibility, acceptability, and equity. Clinical practice guidelines sometimes get a bad rap but Dr. Lang explains why they ultimately should sit atop the evidence hierarchy.   We also discuss game-changing AI applications in EMS: consolidated electronic health records enabling precision prehospital care, automated documentation, predictive analytics for patient destination, and an AI tool providing evidence synthesis with references in seconds.    Whether you're a paramedic, nurse, or physician, this episode has the power to change how you evaluate and apply clinical evidence.   Subscribe for more evidence-based EMS content that cuts through the noise so that you never lose sight of the forest through the trees. Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae   Guest/Cast/Crew information- Guest- Eddy Lang, MD Hosts- Ross Orpet, Will Berry    Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Understanding the toxidromes provides you with vital diagnostic tools in high-stakes environments. In this episode, we break down the clinical patterns that define. Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae toxidromes- the clusters of signs and symptoms that point to poisoning or overdose. We explore the hallmark features of the most common toxidromes, highlight common pitfalls in recognition, and explain how early pattern recognition changes patient outcomes. But not all symptoms are what they seem. In this episode, we peel back the layers of toxidromes to show how overlapping signs can mislead even experienced providers. From pinpoint pupils to altered mental status, we examine which clues you can trust and which demand a deeper look. Packed with real-world relevance, this discussion will sharpen your clinical instincts and prepare you for the next toxicological mystery.     Guest/Cast/Crew information- Hosts- Ross Orpet, Will Berry    Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Melody Bishop helps us simplify the physiology of bag-valve-mask (BVM) techniques. This episode highlights common mistakes like insufficient exhalation time, discusses driving pressure, and explains the importance of proper technique to avoid lung injury. We also explore the nuances of endotracheal tube size, laminar flow, and the transition from BVM to mechanical ventilation. From FASTCAN in Calgary this episode will enhance your understanding and skills in respiratory care. Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae   Resources Episode supplemental blog post and show notes Melody’s Free Book on mechanical ventilation  Guest/Cast/Crew information- Guest- Melody Bishop, RRT, CCAA Host- Ross Orpet, Will Berry    Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Dr. Jeff Jarvis, EMS medical director and host of the EMS Lighthouse Project, delves into the latest emerging EMS literature and guidelines from the National Association of EMS Physicians. We explore best practices for blood use in trauma, up-to-date trauma arrest recommendations, postpartum hemorrhage, and severe hypertension in pregnancy. Additionally, we discuss recent studies on field intubation times, pre-hospital treatment of AFib with RVR, and pre-treating with calcium before diltiazem for patients in AFib. This episode is packed with crucial, evidence-based information for best practices in the prehospital setting. Don't miss out! Website show notes link Episode on YouTube   Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae   Resources EMS Light House episode on pretreatment with calcium before diltiazem in Afib The Resus Tailor  Guest/Cast/Crew information- Guest- Dr. Jeff Jarvis Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

What's the real difference between paramedics who stay calm under pressure and those who panic when everything goes wrong? It's the ability to already know what comes next. In this episode we explore the power of consistency and how one simple tool, often dismissed, can improve patient care and outcomes. Geoff Murphy, founder of Master Medics, sat down with us onsite at FAST25 to discuss how checklists can not only save lives but allow you to remain confident in knowing what is next on scene. Not to mention they're a great training tool as well. Resources Episode supplemental blog post- https://emspodcast.com/the-power-of-a-simple-tool-in-high-stakes-environments/  The Resus Tailor - https://www.theresustailor.com/ Podcast announcements: The Loud & Clear Fellowship Program is officially underway. Stay tuned for updates on how everything is going. If you want to join a waitlist to be able join in the next cohort email us at [email protected] Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information- Guest- Geoff Murphy Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com   Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae   American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Were have we been? Well, the truth is, we've been incredibly busy working on some really exciting projects. If you're interested in joining the founding members cohort of  The Loud & Clear Fellowship Course reach out to me at [email protected] before August 15th. Project #1: Understanding New Paramedic Challenges We launched a research project diving deep into understanding exactly what newer paramedics struggle with as they make that transition from school into the real world of EMS. We all remember that feeling - you graduate paramedic school, you pass your registry, you get your first job, and then... reality hits. The textbook scenarios suddenly become real patients with real families, real emergencies, and real consequences and it turns out none of those patients read the textbook. There's this gap between what you learned in class and what you need to know to be truly confident and effective on the streets. We've been talking to new paramedics, experienced providers, educators, and EMS leaders to really understand where those gaps are. What are the specific challenges? What makes the difference between a new paramedic who struggles and one who thrives? This research has been fascinating, and it's going to inform not just the educational episodes we create going forward, but it's also led us to our next project. Project #2: The Loud & Clear Fellowship Course This is what we're most excited about - we've developed what we're calling right now The Loud & Clear Fellowship Course. This isn't just another continuing education program. This isn’t just a set of pre-recorded lectures. This is about taking everything we've learned from our research and creating a comprehensive program to help bridge that gap between school and street confidence. I'm talking about mentorship, coaching, practical scenarios, decision-making frameworks, and most importantly - building the kind of unshakeable confidence that lets you walk into any call knowing you've got the tools and mindset to handle whatever comes your way. We've got a fantastic group of paramedics signed up for our founding members cohort, and we're about to launch in one week. If this sounds like something that might be a good fit for you, we do have a very short window left and only a few spots remaining in this founding cohort, but f you're interested, send me an email before August 15th at [email protected] and we can chat about whether the course might be right for you. Project #3: Continuing Education Credits The third project we've been working on is the ability to get continuing education credits for listening to our episodes. We're currently beta testing this system, and I'm optimistic that we'll have it ready to launch by the end of the year.  Looking Ahead So that's what we've been up to.  The good news is we're back on track. We hope to have our next regular episode released next week, so tune in for some more of that high-level continuing education you've come to expect from us here at Loud and Clear. Thank you again for being such an incredible community. Your support, your feedback, your engagement - it all matters. It's what drives us to keep pushing forward and finding new ways to serve you better. Until next time, stay safe out there, keep learning, and remember - every call, no matter how big or small, is an opportunity to make a difference. Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Renowned airway enthusiast, Dr. Rich Levitan, on mastering airway management. Explore his approach to simplifying complex tasks into achievable and believable steps. Every complexity incurs a debt to crisis performance, instead, learn how we can decrease stress and engineer success in crisis performance. Resources YouTube link- https://www.youtube.com/watch?v=UWMJS-pKYKw The Resus Tailor - https://www.theresustailor.com/ Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae Guest/Cast/Crew information- Guest- Dr. Rich Levitan Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

We dive into the latest emergency medicine research evaluating the complications following pre-hospital tourniquet use. Dr. Ben Li, an expert in emergency medicine literature reviews a 2023 study titled 'The Cost of Saving Lives: Complications Arising from Pre-Hospital Tourniquet Use,' exploring its implications for EMS providers. From infection to compartment syndrome, we discuss the potential downstream complications and we do so reviewing step by step guide on how to critically appraise current literature. Tune in to ensure your evidence-based care starts in the streets.   01:10 Introducing the Study 03:48 Understanding Study Design and Quality 06:19 Diving into the Study's Context and Background 09:04 Using Appraisal Checklists to Evaluate the Study 10:31 Cohort Study Design and Its Implications 15:31 Selection Bias and Generalizability 22:36 Measurement and Classification Bias 24:45 Understanding Confounding Variables 25:51 Evaluating Study Methods and Follow-Up 27:43 Analyzing Study Results 31:21 Complications and Their Implications 34:33 Multivariable Analysis Insights 36:49 Practical Applications and Future Research 46:24 Final Thoughts   Resources The Resus Tailor - https://www.theresustailor.com/  Critical Appraisal Checklists- https://casp-uk.net/casp-tools-checklists/    Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Books We Recommend The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information- Guest- Dr. Ben Li Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.co Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

A field trainer administers a non-indicated medication while two trainees watch in silence. Sound familiar? In this eye-opening episode, we dive deep into how the aviation industry transformed from a punitive, hierarchical culture to one where crews actively prevent catastrophic errors—and how YOU can apply these same principles on your next EMS shift. Our guest, Glen, a commercial airline pilot and aviation safety expert, shares how the aviation industry has revolutionized itself through such methodologies as just culture, crew resource management, and error prevention tools like the inquiry, advocacy, assertiveness model. We explore how these principles can be effectively applied in our EMS world to improve safety and performance. By the end of this episode, you'll walk away with practical tactics to implement on your next shift, ensuring you and your crew can handle high-stress situations with confidence and competence. Key Concepts Covered: Crew Resource Management (CRM) Just Culture principles Aviation Safety Action Program (ASAP) Power distance in medical teams Human factors in emergency medicine Error prevention strategies Books Mentioned by Glen: Just Culture by Sidney Dekker - https://amzn.to/3Su0A9Y The Myth of Multitasking: How "doing it all" gets nothing done - https://amzn.to/4dAFa4E  Crew Resource Management Practice and Principles- https://amzn.to/3ZIjXzZ Threat & Error Management resources - https://skybrary.aero/articles/threat-and-error-management-tem Other Resources: The Resus Tailor - https://www.theresustailor.com/  This Episodes Blog Post- https://emspodcast.com/what-airplane-crashes-teach-us-about-saving-lives-in-ems-lessons-in-crew-resource-management-and-just-culture-from-the-aviation-industry/  Gear We Like: Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Other books we recommend: The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information- Guest- Glen Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Effective agitated patient management requires a fundamental shift from viewing these encounters as behavioral problems to recognizing them as medical emergencies with underlying pathophysiological processes. By systematically addressing safety, identifying root causes, selecting appropriate pharmacological interventions, and maintaining rigorous post-sedation monitoring, EMS providers can dramatically improve outcomes for these challenging patients. Remember: you cannot talk someone out of a hypoglycemic crisis, hypoxic emergency, or sympathomimetic overdose. When verbal de-escalation fails, it's not your failure as a provider—it's an indication that medical intervention is required to address the underlying pathophysiology driving the patient's agitation. The goal isn't just to control behavior—it's to provide definitive medical care that addresses the root cause of the patient's distress while maintaining safety for everyone involved.   Our guest is Patrick Hendley, a practicing paramedic and an expert in agitated patient management. We'll explore the pathophysiology behind agitation and essential strategies for EMS providers faced with these calls. We'll also examine sedation choices, restraint use, and post-sedation care through a lens of real-world EMS principles. Join us as we look at more than just de-escalation, but understanding and acting effectively and ethically to safeguard everyone involved.   Don't forget to check out our sponsor, The Resus Tailor, for custom bag designs tailored to your EMS needs. Reach out to them at theresustailor.com.    00:00 Introduction to Loud and Clear EMS 00:27 Today's Topic: Managing the Agitated Patient 01:00 Guest Introduction: Patrick Henley 02:17 Sponsor Message: The Recess Tailor 03:01 Case Study: Agitated Patient Scenario 06:04 Understanding Agitation and Safety Principles 08:12 Sympathetic Nervous System and Agitation 10:00 Factors Contributing to Agitation 13:02 Drug Influence on Agitation 19:05 Safety Hierarchy in EMS 30:34 Transport Safety and Patient Management 33:07 Treating Underlying Causes of Agitation 39:08 Managing Patient Anxiety with Fentanyl and Oxygen 39:45 Using Ketamine for Pain Control and Sedation 40:25 Addressing Mixed Presentations: Schizophrenia and Substance Use 41:38 Treating Sympathomimetic Overdose and Psychosis 42:56 The Importance of Post-Sedation Monitoring 43:51 Verbal De-escalation and Benzodiazepines 45:00 Using Time as a Tool for Postictal Patients 46:11 Understanding Benzodiazepines and GABA Receptors 47:59 Antipsychotics and Ketamine: When Benzos Aren't Enough 59:17 The Role of Physical Restraints in Patient Management 01:08:43 Effective Handoff and Continuity of Care 01:18:11 Final Thoughts and Core Principles   Resources The Resus Tailor - https://www.theresustailor.com/ The Art of Managing Agitated Patients Supplemental Blog Post - https://emspodcast.com/the-art-of-managing-agitated-patients/ Gear We Like Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Guest/Cast/Crew information- Guest- Patrick Hendley Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Let's delve into the critical steps required to manage an upper GI bleed in the field. This episode breaks down the recognition of risk factors, vital airway and circulation interventions, and best practices for transporting and notifying the hospital. We discuss important historical clues and provide insights on airway handling and circulatory support. Learn how to navigate these time-sensitive emergencies with speed and thoroughness to improve patient outcomes.  00:30 Host Introduction and Episode Overview 01:22 Recognizing Upper GI Bleeds 01:45 Sponsor Message: The Resus Tailor 02:38 Four Clues to Identify GI Bleeds 06:17 Critical Questions for GI Bleed Patients 09:47 Airway Management Strategies 15:21 Circulatory Support and IV Access 19:26 Medication Considerations 22:28 Transport and Hospital Notification 23:41 Conclusion and Viewer Engagement   Resources Get 10% off FAST25 with promo code- loud&clear The Resus Tailor - https://www.theresustailor.com/ Website show notes link Other episodes you might like: Podcast announcements Survey- Help us learn what content you want Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information- Guest-  Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

These challenging scenarios represent opportunities to provide truly patient-centered care at life's most vulnerable moments. By combining your medical expertise with thoughtful communication, you can help ensure patients' wishes are honored while supporting families through difficult transitions. In this episode we dive into the complex ethical and legal dilemmas faced by EMS providers when arriving on scenes involving Do Not Resuscitate (DNR) and goals of care forms. With special guest Dr. Daniel Markwalter, an emergency physician and hospice/palliative care expert, the discussion touches on understanding the importance of these forms, the challenges of making decisions without clear directives, and strategies for effective communication with family members when they suddenly disagree with the form. This episode provides valuable insights and practical advice for EMS professionals who can be faced with these sometimes challenging scenarios.   00:00 Introduction: The Ethical Dilemma in EMS 00:49 Sponsor Message: The Recess Tailor 01:53 Case Study: Evening Shift Dilemma 03:33 Expert Insights: Dr. Daniel Mark Walter 04:40 Understanding Hospice and DNR 09:48 Advanced Directives and Code Status 19:20 Challenges with Comfort Care and Advanced Directives 26:19 Aligning Medical Knowledge with Patient Goals 28:34 Understanding Goals of Care 29:03 Respecting Autonomy in Medical Decisions 30:02 Effective Communication with Families 31:45 Navigating Family Overrides in Critical Moments 32:36 Legal Aspects of Surrogate Decision Making 36:00 Exploring Illness Understanding and Prognosis 45:46 Symptom Management in Palliative Care 49:43 Final Thoughts and Summary   Resources Get 10% off FAST25 with promo code- loud&clear The Resus Tailor Todays Episode Show Notes Survey- Help us learn what content you want Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information- Guest- Daniel Markwalter, MD Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae   American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Get 10% off FAST25 with promo code- loud&clear. In this special episode of Loud & Clear: EMS Guiding Principles, we learn from the wisdom of 2 industry leaders with nearly 70 years worth of combined experience, Allen Wolfe and Michael Frakes. This episode explores the evolution of EMS education, effective training strategies, and the importance of lifelong learning. Whether you're an educator, a learner, or just passionate about EMS, you'll find valuable insights on how to improve your skills and knowledge. Enjoy this bonus episode filled with expert advice, engaging discussions, and practical tips to level up your EMS game!    00:00 Episode Quotes 00:38 Welcome to Loud and Clear EMS 01:19 Upcoming Fast 25 Conference 02:10 Meet the Guests: Allen Wolfe and Michael Frakes 04:20 Allen's Background and Experience 05:41 Changes in Clinical Education 07:51 Future of Education: VR and Edutainment 09:09 Advice for Education Directors 11:34 Field Training Officer Tips 15:08 Choosing the Right Workplace for Critical Care Experience 16:31 Real-Life Trauma Cases and Lessons Learned 19:36 The Importance of Self-Education and Lifelong Learning 21:48 Michael Frakes Introduction- Insights from a Career in Critical Care Transport 22:44 Advancements and Challenges in Medical Education 27:59 Final Thoughts and Key Takeaways Resources The Resus Tailor - https://www.theresustailor.com/ Get 10% off FAST25 with promo code- loud&clear Survey- Help us learn what content you want Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information- Guest- Allen Wolfe, Michael Frakes Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae   American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Let's discuss the intricacies of evidence-based medicine (EBM) with Dr. Ben Li. The conversation dives deep into understanding different types of medical studies, their hierarchies, and how EMS providers can apply them to their practice. The episode covers evaluating research, the importance of study design, confounders, sample size, and how to discern the relevance and applicability of research findings. Dr. Li provides practical advice for critically appraising literature and emphasizes doing so in a way that is personally relevant to the listener's practice. This episode is essential for anyone in EMS or emergency medicine looking to deepen their understanding of medical research and how it impacts patient care. Enter to win Airpods, Cric-a-lot, and a belt buckle! Resources that can help Critical appraisal guides: https://casp-uk.net/casp-tools-checklists/ (my personal favorite) https://jbi.global/critical-appraisal-tools Reporting guidelines (similar to appraisal guides, but more are standards for the investigators to use and follow): https://www.equator-network.org/reporting-guidelines   00:00 Introduction and Priorities 00:34 Show Restructure Announcement 01:42 The Evolution of EMS Practices 03:57 Understanding Evidence-Based Medicine 05:23 Interview with Dr. Ben Lee 07:20 Approaching and Appraising Medical Studies 08:14 Challenges in EMS Research 13:47 Study Design and Hierarchy 31:33 Applying Research to Practice 39:26 Final Thoughts and Takeaways   Resources The Resus Tailor Enter to win Airpods, Cric-a-lot, and a belt buckle! Website show notes link Other episodes you might like: Podcast announcements Survey- Help us learn what content you want Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information- Guest-  Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae   American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

We discuss the importance of equipment design in EMS with Adam LaChapelle, founder of The Resus Tailor. Together we delve into the impact that effective design has on performance and patient outcomes, exploring principles such as reducing friction and visual checklists. Adam shares compelling stories and practical tips on organizing your equipment to enhance efficiency and care. The episode also includes a special giveaway announcement for listeners. SPECIAL GIVEAWAY- AirPods, Cric-a-lot, Belt Buckle   00:00 Introduction to Bag Design Challenges 00:44 Real-Life Emergency Scenario 02:33 The Importance of Equipment Layout 03:15 Exciting Announcements and Rebranding 04:00 Meet the Hosts and Today's Guest 05:27 Adam LaChapelle's Journey and Passion 11:32 The SCRAM Bag and Its Impact 16:20 Principles of Effective Design 21:42 Innovative Bag Design for Quality Care 22:19 The Importance of Iteration in EMS Gear 23:49 Key Considerations for Bag Design 28:05 Reducing Friction in Emergency Response 30:46 Challenges and Solutions in EMS Bag Design 35:33 Customizing Bags for Specific Needs 36:54 Practical Tips for EMS Providers 39:40 Partnering with Recess Tailor for Custom Solutions 42:45 Exciting Giveaway Announcement 44:03 Summary and Key Takeaways   Resources SPECIAL GIVEAWAY- AirPods, Cric-a-lot, Belt Buckle The Resus Tailor Website show notes link Podcast announcements- NEW NAME, Loud & Clear: EMS Guiding Principles Survey- Help us learn what content you want Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information- Guest- Adam LaChapelle, Founder and CEO of The Resus Tailor Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- @emsloudandclear Website- www.emspodcast.com Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae   Creative Commons - Attribution 3.0 Unported - CC BY 3.0 Music sponsored by Audio Library https://youtu.be/JoyIRE5k2Yo Daylight by Alex-Productions https://soundcloud.com/alexproductionsmusic American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear

Hello everyone, we have an exciting announcement. Today we are announcing our brand new name: Loud & Clear: EMS Guiding Principles. My name is Ross, and alongside my co-host, Will, we're thrilled to present this fresh chapter in our podcast journey. Let's start with why we're rebranding and renaming. For close to five years now, we've been bringing you valuable continuing education through our podcast, originally named EMS Cast. Each year we have become more and more dedicated to our mission. However, as time passed, it became clear that our name didn't quite capture the essence of what we stand for—our mission or our identity as educators in the EMS field. Will and I devoted significant effort into clarifying our mission this last year. Determining how we could create a framework to help you navigate the inevitable uncertainties in EMS, to put an emphasis on what truly and what principles will guide you through the uncertainty. This framework is going to allow us  to bring you even better content with clearer messaging. We wanted a name that resonates with our commitment to provide in-depth discussions that extend beyond paramedic school learning but yet never loses sight of the fundamentals and guiding principles that actually matter. After months of brainstorming and reflection, Loud & Clear: EMS Guiding Principles felt like the perfect match—an embodiment of our dedication to make every lesson resonate strongly and clearly with you, the listener. In the world of EMS, ‘loud and clear’ is a phrase many of us know very well, whether you’re checking in with dispatch over the radio at the start of your shift or confirming the receiving hospital can clearly understand you. It signifies that there is clarity and understanding in the message that is received. We aim to bring this clarity  to every topic we discuss. Reinforcing our commitment to delivering information that is easy to comprehend and apply in real-life EMS situations, even when uncertainty abounds. While our name may have changed and our episode framework has evolved, our mission has not. We will continue to provide high level education, seeking to teach you principles that enrich your knowledge beyond the textbooks you read in paramedic school, preparing you for the unexpected scenarios you’ll face in the field. You won’t find cookie-cutter approaches here—we’re dedicated to helping you understand and fall back on an understanding of fundamental principles that allow you to navigate the uncertainty and chaos with confidence. Each episode of Loud & Clear will present high-level discussions about pathophysiology and treatment options. But more than that, every episode will guide you back to those time-tested EMS principles crucial for effective decision-making. This year promises ever more engaging content rich episodes, with an updated name, cover art, social media presence, and more as we embrace this exciting transition. We can't wait to embark on this new journey with you, our dedicated listeners. Thank you for your support and enthusiasm. Remember—we’re here to ensure your learning experience is loud and clear.   Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: emspodcast.com/free-coaching-call 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae American Burn Association / ABLS: Enter the ABLS giveaway by June 30, 2026; the winner will be selected July 1, 2026. Loud & Clear listeners also get 10% off ABLS Now through August 31, 2026. Details: https://bit.ly/aba-loud-clear