EMS Cast

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

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    

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  

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    

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    

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.

Syncope is a symptom, not a diagnosis. Often it's a symptom of a benign etiology but it can indicate a life-threatening condition. So how do we distinguish between the two? We dive into the complex topic of syncope with guest Matt Mendes. We discuss the importance of recognizing syncope, differentiating it from seizures, and identifying who are the high-risk patients and why. The episode covers the guiding principles syncope- a good history, physical exam findings, and the ECG. It also delves into common presentations, risk stratifying strategies, and real-world cases to equip EMS providers with the knowledge needed to manage syncope calls effectively.    00:00 Intro 01:07 Welcome to EMS Cast, host and guest introductions 04:51 Guiding Principles for Syncope Assessment 07:22 High-Risk Syncope Patients 09:14 Initial Approach to Syncope Patients 15:15 Syncope vs. Seizure 20:08 Physical Exam and EKG Importance 25:14 Identifying Arrhythmias in Syncope Patients 26:37 Understanding Wolf Parkinson White Disease 27:46 QT Prolongation and Its Implications 29:49 Left Ventricular Hypertrophy and Its Risks 31:28 Recognizing Brugada Pattern 32:02 Arrhythmogenic Right Ventricular Dysplasia 33:04 Bifascicular Block and Its Dangers 35:00 EKG Interpretation and Syncope Risk Stratification 39:53 Emergency Department Workups for Syncope 55:49 Case Studies and Memorable Syncope Calls   Resources The Resus Tailor EMS Cast Syncope Blog Post Other episodes you might like: Wide Complex Tachycardia Podcast announcements- WE'RE RENAMING THE SHOW TO, 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- Matt Mendes, EM doc, Resident didactics coordinator, former EMS Cast Co-Host Hosts- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com  

Let's discuss the pressing issue of mental health among first responders, particularly within the EMS community. Will gets vulnerable and shares a personal story of trauma on the job to highlight the urgent need for mental health resources and support. Unfortunately, his story is not unique, we will all experience some level of emotional trauma while on the job. This episode features Jessica Nelson, the coordinator of the groundbreaking program and first of its kind state legislation, PATH4EMS. PATH4EMS provides free and confidential mental health care for EMS professionals. We delve into strategies for normalizing mental health conversations, the importance of trauma-informed care, and the benefits of proactive mental health practices. The discussion also covers the need for tailored, evidence-based resources and the unique challenges faced by rural first responders. Tune in to learn about the vital steps being taken to ensure the well-being of those who brave the front lines.   00:00 The Struggles of First Responders 00:53 A Personal Story of Trauma 04:57 The Turning Point: Seeking Therapy 05:42 Introduction to EMScast 06:34 Meet Jessica Nelson: A Pioneer in EMS Mental Health 09:54 The Importance of Confidentiality and Specialized Care 12:17 Effective Mental Health Practices for EMS Providers 19:54 Path for EMS: A Groundbreaking Initiative 30:37 Future Directions and Final Thoughts   Resources PATH4EMS website Today's Sponsor- The Resus Tailor Today's episode blog post Podcast announcements- We're rebranding! New name will be- Loud & Clear: EMS Guideline Principles. Look out for the changes coming soon. 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- Jessica Nelson, PATH4EMS coordinator Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com  

Learn a systematic approach to management of wide complex tachycardia that doesn't rely on exact rhythm identification or scoring systems with guest Dr. Kevin Butler. By understanding the physiology rather than memorizing a score or algorithm you can use Kevin's approach and ABCD mnemonic to help differentiate between ventricular tachycardia, SVT with aberrancy, and other arrhythmias. Learn how not to miss the vital mimics with his SPAM filter. And finally by understanding which treatments are safe and which treatments potentially dangerous you can understand how to move forward even when you're not exactly sure what the arrhythmia is. Whether you're an EMT, paramedic, or emergency physician, this episode provides the essential principles and stepwise strategies to ensure effective and safe patient management. 00:00 Introduction to Arrhythmia Management 00:29 Personal Anecdote: Lessons from Paramedic School 02:04 Introducing Dr. Kevin Butler 02:16 Sponsor Message: The Recess Tailor 03:35 Welcome to EMS Cast 04:04 Understanding Wide Complex Tachycardia 05:37 Approach to Arrhythmia Management 07:02 Principles of Managing Wide Complex Tachycardia 08:39 Pathophysiology of Wide Complex Tachycardia 18:30 Identifying and Treating Mimics 26:55 Regular vs. Irregular Wide Complex Tachycardia 29:59 Understanding Torsades and Its Management 30:25 Identifying Atrial Fibrillation with Pre-Excitation 32:14 Treatment Considerations for AFib with WPW 35:02 Distinguishing Between VT and SVT with Aberrancy 37:09 Physiological Approach to ECG Interpretation 40:24 ABCD Mnemonic for VT Diagnosis 47:49 EMS Treatment Protocols for Wide Complex Tachycardia 51:54 Pre-Hospital Cardioversion Tips 55:22 Emergency Department Approach to Wide Complex Tachycardia 58:00 Final Thoughts and Key Takeaways Resources The Resus Tailor Episode Blog Post with EKG examples 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- Dr. Kevin Butler, Emergency Physician, Lead Instructor for DHREM's EKG didactic curriculum Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com  

You've looked at other paramedic continuing education resources but it's the same basic material they taught you in school. There's more you need to know, or you might miss something, someone might get hurt, or worse someone might die. You don't feel ready. Your goal is to control the chaos. To become an expert in the field of prehospital medicine. And this is all driven by the desire to be there for someone on the worst day of their life. To change an outcome that would have otherwise been catastrophic if you weren't there. There's no resource for the practicing paramedic to plug the holes that were left behind by paramedic school. Everything seems stuck in basic algorithms of “A” then “do B” but what do you do when "A” wasn't in the book. We need to get away from the algorithmic thinking and instead shift to understanding the principles behind WHY if A then B. The truth is, you can't learn it all. Emergency Medicine includes too many pathologies and 911 calls are too unique and chaotic to know the answer to every situation. Instead of trying to learn every answer to every call, you need guiding principles for your knowledge to stand on. If you build these principles they become the foundation for every call no matter the complaint, for every situation, no matter the chaos surrounding you. If you have the foundation you can be stable when the storm comes. You can know when to push forward or when to change course. And then each additional piece of advanced content that you learn can be added to that foundation to build on, because mastery is not a destination, it's a journey and the journey never ends. We are your hosts, Ross Orpet & Will Berry and this is EMS Cast. Come on this journey with us to mastering emergency medicine. We will cover topics in more depth than you learned in paramedic school, we will teach one step further and talk about what will happen to that patient in the Emergency Department after you drop them off. And we will connect all of this back to the principles that will guide you not just on this call but on all the calls. These principles will allow you to answer the question, at the end of the day, what's really important to me, the paramedic, in the field, in that moment. You may not feel ready, you may not feel like you know enough, but you can understand the principles and that will make all the difference. Because what you do matters.

Joined by Josh, Cody, and Moose from the AlertMedicOne podcast, we explore key principles of good training, leadership, and the importance of making mistakes in a safe learning environment. We discuss strategies to foster critical thinking, introspection, and continuous improvement among trainees in the EMS field. A big part of EMS is learning to be a leader and a teacher no matter what level you are at so whether you are a trainee, a field trainer, teach students during their rides, or merely work with a partner there's something for everyone to learn in this one. Tune in for an insightful discussion on how to develop and become excellent EMS professionals through solid training and leadership.   00:00 Whitewater Rafting Adventure 00:25 The Importance of Training 01:02 Creating a Safe Learning Environment 01:43 Introducing the AlertMedicOne Podcast 02:06 Meet the Hosts 04:37 Whitewater Rafting Lessons for EMS 05:48 Encouraging Autonomy in Training 08:01 Balancing Guidance and Independence 10:25 The Role of Field Training Officers 15:03 Ownership and Leadership in EMS Training 24:50 Handling Mistakes and Failures 31:33 Striving for Continuous Improvement 34:11 Embracing Continuous Improvement 34:34 Learning from Experienced Paramedics 35:35 The Importance of Preparation 36:47 Humility and Self-Awareness 38:23 Handling Mistakes and Growth 40:12 Training and Mental Health 41:54 Effective Preceptorship 43:13 Teaching Techniques in Action 45:12 Building Confidence in Trainees 47:21 The Role of a Trainer 01:03:06 Final Thoughts and Reflections   Resources Contact The Resus Tailor Watch this episode on YouTube Read the blog post for this episode Other episodes you might like: Values Driven Leadership with Chris Pfingsten from EMS 20/20 podcast 10 lessons from a real austere rescue How to Master the Resuscitation - EMCRITs Scott Weingart Podcast announcements- Big news coming in 2025! Stay Tuned! 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- Josh, Cody, Moose Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com      

Explore the crucial distinction between providing equal care versus equitable care within emergency medical services (EMS). We give you an in-depth discussion with Ritu Sani from The EMS Show podcast, highlighting the importance of focusing on outcome-driven quality improvement projects and addressing disparities in care. Learn how different demographics face unique barriers to healthcare, and why recognizing these differences is essential to improving outcomes across various communities. Watch as real-life examples illustrate the need for equitable interventions and the systemic factors that contribute to inequities in EMS.   00:00 Introduction: Equal vs. Equitable Care 00:23 Case Study: CPR Training Disparities 01:09 Understanding Barriers to Equitable Care 03:31 Guest Introduction: Ritu Sani from EMS Show Podcast 04:33 Interactive Exercise: Demonstrating Inequity 06:36 Quality Improvement: Focusing on Outcomes 08:09 Challenges in Achieving Equitable Care 09:25 Diversifying EMS Workforce 10:11 Systemic Factors and Data-Driven Solutions 11:03 Starting with Equitable Care 11:17 Key Areas to Focus On 11:26 Analyzing Data for Disparities 12:12 Addressing Provider Reactions 13:00 Implementing Quality Improvement 13:35 Implicit Bias and Introspection 14:17 Patient Outcome Driven Approach 14:33 Challenges and Structural Abnormalities 15:16 Conclusion and Final Thoughts   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 For Leaders:  For those looking to get better: For fun: Guest/Cast/Crew information- Guest- Ritu Sani, MD and Co-host of The EMS Show podcast Host- Ross Orpet, Chris Pfingsten from EMS 20/20 Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com

Dr. Avery McKenzie interviews Dr. Eric Adler, regional medical director for Flight for Life, about the challenging and rare procedure of field amputations. They discuss the importance of being prepared for the unexpected, the steps involved in developing a protocol for such emergencies, and the logistical challenges faced during the process. Dr. Adler shares insights from real-life cases and emphasizes the critical need for planning and knowing the resources available in urgent scenarios.   00:00 Emergency Field Amputation: A Real-Life Scenario 00:25 The Reality of Unlikely Medical Emergencies 02:04 Introducing Today's Episode and Guest 04:26 Dr. Eric Adler's Experience and Protocol Development 05:46 Indications and Procedures for Field Amputation 10:50 Challenges in Creating a Field Amputation Protocol 14:23 Final Thoughts and Preparedness   Resources Website show notes link (picture of the kit and copy of the protocol): https://emspodcast.com/life-over-limb-field-amputation-preparing-for-the-unthinkable/ Other episodes you might like: Episode 31- You Were Taught Wrong, Traumas Not Algorithmic 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- Erik Adler Host- Ross Orpet, Avery Mackenzie Catch up with us after the show Instagram- @emscast Website- www.emspodcast.com  

In this episode, we discuss the profound impact that one patient's organ donation can have on society. Even when not every patient gets to go home, the ability to donate organs can positively affect up to 80 people, multiplying our impact and service to the community. Guest Chris Meeks, a critical care flight paramedic and organ recovery coordinator discusses the ethical considerations and the surprising impact EMS has on the potential for organ donation, even in cases that appear to be 'lost causes'. Tune in to understand how your work in EMS may have more far-reaching positive effects than you realize.   00:00 Introduction: The Impact of EMS on Organ Donation 00:43 Ethical Considerations in Organ Donation 01:10 Current Research and EMS's Role 02:04 Guest Introduction: Chris Meeks 05:04 Ethical Dilemmas and Future Directions 08:25 Organ Donation Criteria and Processes 13:28 Conclusion: The Importance of EMS in Organ Donation   Guest/Cast/Crew information- Guest- Chris Meeks, Critical Care Flight Paramedic, Organ Recovery Coordinator Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com

Creating lasting behavioral changes in the workplace by moving beyond consequence-based policies. Chris discusses the importance of aligning personal and company values, highlighting 'just culture' in EMS and its role in understanding motivations and systemic issues. The conversation covers leadership in EMS, focusing on the significance of fostering supportive relationships with staff and avoiding fear-based management. Additionally, Chris shares his journey from paramedic to Field Training Officer, offering advice on effective training and mutual support. This episode is packed with valuable insights for anyone in the EMS field aiming to enhance performance, commitment, and team dynamics. Don't forget to check below for further resources on just culture and motivational learning.   Guest/Cast/Crew information- Guest- Chris Pfingsten, Co-host of EMS 20/20 Host- Ross Orpet, Will Berry    Resources Other episodes you might like Ep. 72 From Errors to Excellence with Geoff Murphy, Master Your Medics Books Just Culture- https://amzn.to/4eOMN7w Crucial Conversations- https://amzn.to/3BRBnRI  YouTube Videos-  Why do Errors Happen? How can we prevent them? How can a system get organized for improvement?    Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com

We delve into the management of esophageal foreign body obstructions, a common yet often misunderstood medical emergency. We discuss the symptoms and causes of esophageal food impactions, sometimes referred to as 'Steakhouse Syndrome,' and differentiate it from tracheal obstructions. We explore the protocols, potential treatments, and if there's any rationale behind treatments such as glucagon administration. Join us as we also share real-life scenarios to better illustrate the challenges and solutions when dealing with such medical cases.   Resources and links This episode was inspired by an article on EMSAirway.com- Friday Night Lights- Shift 9 Steak Night  EMScast15 - code for 15% off an awesome pair of sunglasses  Help Us By Filling Out Our Audience Survey  Medic Box - awesome medical gear shipped directly to your door  Articles- American Society for Gastrointestinal Endoscopy- Guidelines for ingested foreign bodies   Glucagon for Relief of Acute Esophageal Foreign Bodies and Food Impactions: A Systematic Review and Meta-Analysis.   Efficacy of cola ingestion for oesophageal food bolus impaction: open label, multicentre, randomised controlled trial   Conservative management of oesophageal soft food bolus impaction   Esophageal Food Impaction: A Retrospective Chart Review Food Bolus Impaction- Question and Answer Review     Guest/Cast/Crew information- Host- Ross Orpet, Will Berry    Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com   00:00 Introduction to Esophageal Foreign Bodies 00:43 Audience Survey and Sunglasses Giveaway 01:46 Interview with Contest Winner 06:11 A Choking Incident at Mile High Stadium 09:02 Discussion on Esophageal Obstructions 11:46 Life-Saving Story at Denver International Airport 13:28 A Life-Saving Outcome 14:11 The Choking Incident at the Tavern 14:57 Assessing the Patient's Condition 19:38 Understanding Esophageal Food Impaction 21:49 Treatment Options and Challenges 29:01 The Role of Endoscopy 37:45 Managing Esophageal Impactions in the Field 39:32 Final Thoughts

In this episode, we delve into a real-life rescue mission conducted by the U.S. Air Force Pararescue Jumpers (PJs) in the North Atlantic Ocean. Dr. Michael Lauria shares ten critical lessons from this challenging scenario that are essential for medical professionals working in any prehospital environment. From the importance of preparation and the power of a small team, to the significance of continuous learning and the dynamic nature of safety, these insights are invaluable for enhancing clinical practice. Tune in to learn how these lessons can be applied to improve how you approach the job.  EMScast15 - code for 15% off an awesome pair of sunglasses  Tell us about you and how we can make this show better  Medic Box - awesome medical gear shipped directly to your door  Guest/Cast/Crew information- Guest- Dr. Mike Lauria Host- Ross Orpet, Will Berry  Resources Other episodes you might like Third-party websites where you can learn more Podcast announcements Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com

In this special bonus episode of EMS Cast, we delve into the story of Bobby Sue McCollum, an emergency nurse turned inventor. Learn about the critical issue of over ventilation in emergency medicine, the innovative VT Select device designed to address this problem, and the crazy inspiring journey of its creation. With discussions on the challenges of finding the optimal ventilation rates and volumes, the episode balances medical data and personal narrative. Bobby Sue shares the highs and lows of her entrepreneurial path, from initial prototype development to eventual licensing, offering valuable insights for aspiring inventors in the medical field.   Resources Mentioned in the Show- VT Select Bag Valve Mask A Review of Ventilation in OHCA Pediatric BVM Delivers More Ideal Volumes in Mannequins Small BVMs Lead to Decreased Survival in a Small Real World Study  00:00 The Problem with Overventilation 00:53 Introduction to the VT Select Device 02:01 Meet the Inventor: Bobby Sue McCollum 05:06 The Journey of Invention 12:10 How the VT Select Works 14:04 Challenges and Triumphs 27:37 Advice for Aspiring Inventors 31:15 Conclusion and Final Thoughts

Explore anaphylaxis care from the basics to the critical approach to managing severe anaphylaxis with Bruce Hoffman, FlightBridge ED senior educator. Find out what it means to be aggressive with anaphylaxis care explained through the AMAX4 framework.  Learn how the framework can help reverse anaphylactic shock and prevent catastrophic outcomes. Hear the impactful story behind the framework and gain insight into the most effective practices for treating unresponsive anaphylactic and asthmatic patients. Special thanks to the McKenzie family for their mission-driven educational work.  Resource links Episode Blog Post / Show Notes  AMAX4 website Anaphylaxis deep dive Updated Anaphylaxis Definition  EMScast15 - code for 15% off an awesome pair of sunglasses  Help us learn how to make this show better for you  Medic Box - awesome medical gear shipped directly to your door  Guest/Cast/Crew information- Guest- Bruce Hoffman- Goodwin University Program Director and Assistant Professor, FlightBridgeED senior educator, Bay State Health Critical Care RN and Paramedic Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com

The Power of Embracing Mistakes- Special guest Geoff Murphy, founder of Master Your Medics, shares how acknowledging and learning from mistakes can save lives in the field of prehospital medicine. Recorded at the Fast 24 conference, this episode emphasizes the importance of cultivating a culture of safety, vulnerability, and continuous learning within EMS teams. Discover actionable strategies to foster a psychologically safe environment where mistakes are openly discussed and used as invaluable learning tools to enhance professional development and patient care. This insightful discussion is a must-watch for anyone looking to elevate their skills and create a high-performing EMS team. EMScast15 - code for 15% off an awesome pair of sunglasses Enter to Win a FREE Pair of Frontline Optics Sunglasses Medic Box - awesome medical gear shipped directly to your door Guest/Cast/Crew information- Guest- Geoff Murphy, founder of Master Your Medics Host- Ross Orpet, Will Berry    Resources Ep. 31 You Were Taught Wrong, Traumas Not Algorithmic MasterYourMedics.com Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com 00:00 Introduction: The Power of Discussing Mistakes 00:38 Welcome to EMS Cast 00:52 Today's Topic: How Mistakes Can Save Lives 01:16 Embracing Failure: Insights from Jeff Murphy 01:37 Creating a Culture of Safety and Vulnerability 06:29 The Fearless Organization: High vs. Low Performing Teams 11:49 Personal Stories: Learning from Mistakes 19:15 Master Your Medics: The Journey and Vision 23:43 Conclusion: The Path to Mastery

Think you only need to worry about toxicities that exist in the sea if you live by an ocean? Think again. No matter where you are fish may be on the menu, or there may be a zoo nearby, or a marine enthusiast with an elaborate home aquarium. These toxicities can be seen in Colorado. They can be in Australia or in the US. No matter where you are you have the potential to see one or many of these. From scombroid poisoning to puffer fish, irukandji syndrome, jellyfish, and sea snakes- tune in to this week's episode to learn all about the various poisons that come from the sea with toxicologist Nik Matsler. Website show notes link EMScast15 - code for 15% off an awesome pair of sunglasses Enter to Win a FREE Pair of Frontline Optics Sunglasses Medic Box - awesome medical gear shipped directly to your door Guest/Cast/Crew information- Guest- Dr. Nik Matsler Host- Dr. Ross Orpet and Critical Care Paramedic Will Berry  Resources Other episodes you might likeEpisode 26: Snake Bites Episode 25: Cocaine Overdose Third-party websites where you can learn moreMarine Envenomations Journal Article 5 Step Approach to Marine Envenomations Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com

Understanding and Managing the Sick Runner: Key Insights for EMS Providers Welcome to EMS Cast! Join hosts Ross Orpet and Will Berry as they dive into an essential conversation . The team discusses, with Dr. Whitney Barrett, the Medical Director of the Highlonsome 100 mile ultra endurance race, the critical considerations for EMS providers when encountering sick runners during endurance events. Insights on managing ultra-endurance athletes, focusing on conditions such as hyponatremia, dehydration, electrolyte imbalances, and the unique challenges presented by high-altitude races. Learn about effective rehydration and cooling strategies, and the critical role of context in diagnosing and treating affected runners.   EMScast15 for 15% Off Frontline Optics Sunglasses Enter to Win a FREE Pair of Frontline Optics Sunglasses Blog Post and Critical Runner Algorithm- The Critical Care of the Sick Runner   00:00 Introduction and Hosts 00:39 Conference Recap 01:03 Guest Introduction: Dr. Whitney Barrett 01:29 Understanding the Sick Runner 02:29 Medical Considerations for Ultra Marathons 08:15 Common Issues in Ultra Runners 12:45 Responding to Sick Runners 19:42 Fluid Management and Hyponatremia 35:10 Handling Hyperthermia and Hypothermia 44:05 Dealing with Collapsed Runners 53:36 Final Thoughts and Takeaways

EMCRIT's Scott Weingart discusses the concept of being a true resuscitationist. The mindset necessary for providing aggressive, excellent care outside hospital boundaries and the emphasis on the importance of preparation, critical thinking, and meticulous attention to detail in emergency medical situations. Dr. Weingart shares insights on mental simulation, embracing challenges, handling crises efficiently, and continuous self-improvement. We conclude our discussion by exploring the philosophy 'Amor Fati' and underscore the broader impact EMS professionals can have beyond simply saving lives. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Blog Post- How to Master the Resuscitation

Will and I recently attended FAST24, an educational conference hosted by FlightBridgeED in Wilmington, North Carolina. We had a fantastic time meeting industry top speakers, including Eric Bauer, one of the original founders of FlightBridgeED. In today's episode, we delve into Eric's journey in EMS education, how FlightBridgeED was conceived, and the importance of continuous learning. We also discuss the challenges of becoming an expert in the field and tips on improving your skills incrementally. Join us as we explore these valuable insights and look forward to upcoming episodes featuring more stellar guests from FAST24! Blog Post- Building Better Providers

In this episode, we delve into the fascinating and often perilous world of mushrooms. Join us as we explore with Dr. Nik Matsler how these fungi can be a culinary delight, a source of psychedelic experiences, or a deadly hazard. We discuss the challenges of identifying mushrooms, even for experts, and why toxicologists rely on mycologists for accurate identification. We'll break down the different types of mushrooms—non-toxic edible varieties, toxic species, and psilocybin-containing "magic mushrooms." Learn the practical tips for EMS professionals on managing mushroom poisoning, including supportive care strategies and specific interventions for severe cases.    Episode Blog Post- The Perils and Pleasures of Mushrooms

Derek Miller, outreach coordinator for the UNC JC Burn Center, joins us again to explore electrical injuries and lightning strikes. We discuss the various types of electrical injuries, the mechanisms behind these injuries, and the essential steps EMS providers must take to ensure their safety and provide effective patient care. Through real-life case studies and expert insights, this episode delves into the complexities of managing electrical burn patients, the importance of immediate interventions, and the potential long-term sequelae of such injuries. Tune in for practical advice and essential knowledge to enhance your skills in handling electrical emergencies. Here are some additional resources: Electrical Injuries Overview- Nice overview, though not limited to EMS specifically. The references list at end is also a good jumping off spot for those wanting more. Photo examples- Variety of pictures As mentioned at the end, fireworks safety- https://www.safefireworksnc.com/

Explore the nuances of stroke assessments, the challenges EMS professionals face in the field, and the impact of prehospital interventions on patient outcomes. Coco Wham, a former paramedic who's transitioned to a physician, and Dr. Layne Dylla, an associate professor of emergency medicine join us to dive into their ongoing research efforts aimed at defining what matters in prehospital stroke care and refining stroke response protocols. Hear firsthand how evidence-based practices are developed from the ground up in EMS settings. This episode is packed with valuable information to enhance your practice and understanding of stroke care in prehospital environments.

This is Part 2. Derek, an experienced clinician in burn care, joins us to delve into the intricacies and challenges of treating burn patients. This discussion provides valuable insights into the unique aspects of burn injuries, the importance of a comprehensive assessment, and the latest trends in burn treatment. Blog post- The Critically Burned Patient Key Topics Covered Complexity of Burn Injuries: Derek begins by explaining why burn patients require a unique approach compared to other trauma patients. He highlights the potential for burns to mask other critical injuries, underscoring the necessity of a thorough and trauma-informed initial assessment. The 'Big Three' Considerations: The conversation shifts to what Derek refers to as the "big three" — polytrauma, airway loss, and inhalation injuries — which are crucial early considerations in burn care. He stresses the importance of recognizing these potentially life-threatening conditions alongside the burn injury itself. Fluid Resuscitation: A significant portion of the discussion is dedicated to fluid resuscitation, a critical aspect of burn care. Derek talks about the Parkland formula for calculating fluid needs based on the total body surface area affected by burns but a better simpler method is- 500 ml/hr for an adult (

Derek, an experienced clinician in burn care, joins us to delve into the intricacies and challenges of treating burn patients. This discussion provides valuable insights into the unique aspects of burn injuries, the importance of a comprehensive assessment, and the latest trends in burn treatment. Key Topics Covered Complexity of Burn Injuries: Derek begins by explaining why burn patients require a unique approach compared to other trauma patients. He highlights the potential for burns to mask other critical injuries, underscoring the necessity of a thorough and trauma-informed initial assessment. The 'Big Three' Considerations: The conversation shifts to what Derek refers to as the "big three" — polytrauma, airway loss, and inhalation injuries — which are crucial early considerations in burn care. He stresses the importance of recognizing these potentially life-threatening conditions alongside the burn injury itself. Fluid Resuscitation: A significant portion of the discussion is dedicated to fluid resuscitation, a critical aspect of burn care. Derek talks about the Parkland formula for calculating fluid needs based on the total body surface area affected by burns but notes that real-time adjustments are often necessary to avoid complications like over-resuscitation. Pain Management and Ethical Concerns: Derek addresses the ethical and practical aspects of pain management in burn victims. Effective pain control not only improves patient comfort but also aids in overall patient management and long term healing, making it a critical component of the initial response. Assessment Tools and Techniques: Various assessment tools such as the Rule of Nines and the Palmer Method are discussed. Derek explains their applications and limitations, emphasizing that while these tools are helpful for initial assessments, more detailed evaluations are typically conducted at specialized burn centers. Part 2: This is just part 1. Part 2 will be coming May 1st. We will simplify our approach to fluid resuscitation and dive into some nuances of burns and burn care.    Blog post- https://emspodcast.com/the-critically-burned-patient/ Scientific papers mentioned-

Which comes first epinephrine or airway? Out of hospital cardiac arrests involve critical and often complex decisions with sequence and timing of various procedure. What should you prioritize? We examine the nuances of advanced interventions, such as epinephrine and advanced airway placement, through the lens of recent studies, including a notable piece of research published recently in JAMA Network Open. Take a deep dive into the practicalities and philosophies that underpin prehospital cardiac arrest management, emphasizing the significance of basic life support skills and the role of advanced techniques in the pre-hospital setting. This episode engages, educates, and challenges EMS providers on the best practices that could potentially save lives during those critical first minutes of a cardiac emergency.   Articles-  Sequence of Epinephrine and Advanced Airway Placement After Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2024 Feb 5;7(2):e2356863. doi: 10.1001/jamanetworkopen.2023.56863. Association of timing of epinephrine administration with outcomes in adults with out-of-hospital cardiac arrest.  JAMA Netw Open. 2021;4(8):e2120176. doi:10.1001/jamanetworkopen.2021.20176 Epinephrine in Out of Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms. Chest. 2023 Aug;164(2):381-393. DOI: 10.1016/j.chest.2023.01.033 A Randomized Trial of Epinephrine in Out of Hospital Cardiac Arrest. (PARAMEDIC2) New Eng J Med. DOI: 10.1056/NEJMoa1806842 The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial.  Intensive Care Med. 2020;46(3):426-436. doi:10.1007/s00134-019-05836-2

Toxicologist Dr. Nik Matsler teaches us the critical topic of toxic alcohol poisoning. The discussion sheds light on the dangers lurking in everyday household and industrial products that contain methanol, ethylene glycol, and isopropyl alcohol—substances not far removed from the alcohol found in beverages yet capable of causing severe, sometimes fatal, health issues.   Blog Post- Toxic Alcohols

In the high-stakes environment of prehospital medicine, the ability to perform a successful intubation on the first attempt is critical. The complexity of prehospital airway management cannot be understated, given the challenging conditions and the acuity of patients encountered. This episode delves into the strategies and techniques that can significantly improve the success rates of prehospital intubations, focusing on preparation, positioning, and the SALAD (Suction-Assisted Laryngoscopy and Airway Decontamination) method. Blog post- Art of Laryngoscopy- The SALAD technique Additional Podcast Episode- Mac 3 vs 4 podcast episode Additional Resources- Youtube SALAD demonstration Published Article on the SALAD Technique YouTube video of the hypoepiglottic ligament in action Airway Jedi blog post Additional SALAD Resources

Despite the allure of consistent compressions and reduced provider fatigue, does the data actually show that mechanical CPR devices improve outcomes? Tune in for a nuanced exploration of evidence-based practice in emergency medical services. Blog Post- https://emspodcast.com/the-truth-about-mechanical-cpr-devices-what-the-data-really-says/ Original Article- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328162/

Overcoming Fear in Neonatal Resuscitation: A Step-by-Step Guide Blog post: Neonatal Resuscitation Introduction: Welcome to another episode of EMScast, where high-level education meets real-world emergency medical scenarios. Today, we have Dr. Avery MacKenzie, an ER physician from Southwest Colorado, joining us to discuss a topic that often induces stress – neonatal resuscitation. Dr. MacKenzie shares her experiences and insights into handling neonatal emergencies in rural settings. Summary: Dr. MacKenzie opens the episode by acknowledging the inherent fear associated with neonatal resuscitation, especially in rural emergency departments where one might be the sole provider. She emphasizes that despite the fear, the process is not hard, and providers already possess the necessary skills. Key Takeaways: 1. **Facing the Fear:**    - Dr. MacKenzie encourages listeners to remember that while neonatal resuscitation may seem intimidating, the skills required are well within their expertise. 2. **Algorithm Overview:**    - The neonatal resuscitation algorithm is simplified into manageable steps, beginning with stimulating, warming, and drying the baby for the first 30 seconds.    - The next 30 seconds involve providing positive pressure ventilation to initiate breathing.    - Monitoring the heart rate is crucial, and if it remains below 100, providers should focus on correcting ventilation strategies. 3. **Initial Assessment:**    - Dr. MacKenzie introduces a simple three-question assessment for determining the need for resuscitation: term gestation, good muscle tone, and respiratory effort. 4. **Positive Pressure Ventilation:**    - The trigger for initiating positive pressure ventilation is if the heart rate is less than 100 or the baby is apneic or gasping.    - The emphasis is on adequate ventilation, and adjustments, such as using the MR. SOPA mnemonic, can be made to improve ventilation. 5. **Advanced Airway Considerations:**    - While advanced airways, such as intubation, are possible, Dr. MacKenzie highlights that pre-hospital protocols may favor supraglottic airways due to the challenging nature of neonatal intubation and the need to limit pauses in oxygenation and respiratory support. 6. **Continued Support:**    - The algorithm emphasizes a continuous loop of assessment, correction, and reassessment, with the goal of maintaining the baby's heart rate above 100. Conclusion: Dr. MacKenzie wraps up the episode by reassuring providers that familiarity with the neonatal resuscitation algorithm and periodic mental reviews can alleviate the fear associated with these critical situations. The key is to focus on what providers already know and apply those skills with confidence.

Dr. Nik Matsler is back to discuss the treatment of patients with crush injuries and crush syndrome. Dr. Matsler's insight as an emergency physician and a toxicologist are put to work helping us understand the pathophysiology of crush related injuries.  We also try to discuss very practical approaches to these situations which are complex.  No two crush injuries will present the same.  Many variables contribute to the presentation of these patients. Duration of crush, amount of force applied, the size of the body part crushed, all play a role.  There is much EMS folklore about treating these patients prophylactically in order to stave off deadly arrhythmia.  Does this work?  What treatments matter for these patients?  Paramedics and EMS are the first line of care for these patients.  How can you give them the best chance of survival? This episode topic was submitted by a listener! Thank you, and please keep the ideas coming.

Jim Barrick has more than 37 years of experience in Emergency Medical Services and Helicopter Emergency Medical Services (EMS and HEMS).  His humble approach makes him a wealth of wisdom for anyone in this career field.  As kickoff for 2024 we depart from our normal format of short education topics to long term reflection.  If you work in and around EMS and Critical Care Transport, learn from Jim.  Take time to listen to those in your world that have years of experience and expertise.  Take time to be humble and learn the lessons they pass forward.  Many of them have been paid for with hardship.  Take time to reflect on your goals as a provider and how you want to better yourself in 2024!  We sat down with Jim in the kitchen of his North Carolina home to learn about his experience with Orange County, North Carolina and Carolina Air Care.  Jim was in a group of 5, that were the first Flight Paramedics in the state of North Carolina.  They helped pioneer a program that is now a staple of EMS in the State of North Carolina.  Carolina Air Care is a division of UNC Health, a part of the University of North Carolina system.  They currently provide critical care transport to the entire state of North Carolina.  They are affiliated with a level I Trauma Center, Burn Center, and a large multi-specialty educational institution.  If it can happen, Jim has seen it.

We delve into the high-stakes world of postpartum hemorrhage management with the esteemed Dr. Maria Moreira. Joins us to demystify the management of postpartum hemorrhage in the pre-hospital setting. Dr. Moreira presents a systematic approach to intervention. Learn about the four T's of postpartum hemorrhage and on-field strategies like tranexamic acid and uterotonic administration. Dr. Moreira guides us through a concise roadmap for effective pre-hospital care. Tune in for critical insights and be prepared for any obstetric emergency!   Episode Summary: Understanding Postpartum Hemorrhage: Postpartum hemorrhage, or excessive bleeding after childbirth, is a significant concern, occurring in approximately 1-5% of deliveries. The mortality rate associated with postpartum hemorrhage is around 2%, but this can vary globally. Some countries experience mortality rates as high as 20%. Additionally, there's a 10-15% risk of recurrence in subsequent pregnancies, emphasizing the importance of understanding and addressing this issue. Physiological Changes and Risks: Pregnancy induces significant physiological changes, resulting in a high-volume, low-resistance state. The uterus receives ten times the normal blood flow during pregnancy, making postpartum hemorrhage a critical concern. Notably, vital signs might not immediately reflect bleeding, making early detection challenging. Pregnant patients can lose up to two liters of blood without immediate changes in vital signs. Recognizing Post-Delivery Physiological Changes: Understanding the physiological changes in vital signs during and after pregnancy is crucial for pre-hospital providers. Pregnancy induces peripheral vasodilation, causing a slight drop in blood pressure. The heart rate increases by 10-15 points, and the respiratory system undergoes changes, requiring increased oxygen. Although the heart rate goes up in a pregnancy and the blood pressure goes down normaly, it is important that any abnormal vital signs such as a heart rate above 100 and a blood pressure below 100 systolic be treated as abnormal until proven otherwise. Four T's: Causes of Postpartum Hemorrhage: Tone: Involving inadequate uterine contraction, the most common cause. Trauma: Typically lacerations that result during delivery and can lead to significant bleeding. Tissue: Relates to retained placental tissue. Thrombin: Referring to coagulopathy or difficulty in clotting. Approach to Postpartum Hemorrhage in the Field: In a pre-hospital setting, managing postpartum hemorrhage involves a systematic approach. Key steps include: Administration of TXA: Tranexamic acid, if available, can help reduce bleeding. Uterotonic Administration: Oxytocin induces uterine contractions. If not available, can have baby latch which will stimulate the production of moms natural occurring oxytocin. Fundal Massage: Applying firm pressure to the uterus to encourage contraction. Addressing Lacerations: Check for lacerations and apply direct pressure to bleeding points if lacerations are visible. Transport to Hospital: Prioritize getting the patient to the hospital immediately for further evaluation and intervention. Secondary Postpartum Hemorrhage: In some cases, bleeding may occur after the initial 24 hours post-delivery, indicating secondary postpartum hemorrhage. Possible causes include retained products, subinvolution of the placental bed, or infection. In such cases, prompt resuscitation aimed at supportive care of abnormal vitals and transport to the hospital are critical. Summary and Takeaways: Dr. Moreira emphasizes the importance of considering postpartum hemorrhage in every pregnant patient. Pre-hospital providers should be prepared to manage complications by following a systematic algorithm. Early recognition, administration of appropriate medications, fundal message, direct pressure and prompt transportation to the hospital are key components of effective intervention. In conclusion, being proactive and vigilant in managing postpartum hemorrhage in the field is crucial for ensuring the well-being of both mother and child. Regular training, awareness, and a systematic approach are vital for pre-hospital providers to navigate these critical situations successfully.

In this episode Dr. Maria Moreira joins us to talk us through prehospital pregnancy difficult deliveries. We'll discuss how to handle nuchal cords, cord prolapse, breech presentations, and shoulder dystocias.   Videos of each technique- https://emspodcast.com/difficult-deliveries/

In this episode we look at a recent observational study out of the journal of neurology looking at the effectiveness of midazolam when comparing the IV vs IM vs IN routes. We'll discuss the study as well as other studies involving status epilepticus to tease out best practices for your next shift.  This Episodes Journal article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9930617/ RAMPART trial: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3211107/ American Epilepsy Society Algorithm: https://www.aesnet.org/clinical-care/clinical-guidance/guideline-prolonged-seizures?_gl=1*1lmlmse*_ga*MTIzMDc0MjA2NC4xNzAwMDM0ODUx*_ga_GV192D9FPY*MTcwMDAzNDg1MS4xLjAuMTcwMDAzNDg1MS42MC4wLjA. Blog post: 

There are few treatments in our tool box that can have more of a positive impact than non-invasive ventilation. This episode is designed to help you better understand the physiology of how it works and how to use it more effectively. Dr. Bo Burns, the Chair of Emergency Medicine at the University of Oklahoma School of Community Medicine, joins us again for another great discussion.  Blog post- https://emspodcast.com/non-invasive-ventilation-understanding-the-physiology/ Intubation checklist mentioned at the end of the episode- https://emspodcast.com/ou-em-intubation-checklist/

Coco Wham is a paramedic at the Denver Health Paramedic Division. She is also a 4th year medical student and has a masters in integrated sciences.  She is an author on a recent study in the American Journal of Surgery with our previous guest, Dr. Eric Campion.  Their latest study looked at prehospital ETCO2 values and if they were predictive of death and need for massive transfusion as compared to commonly accepted measurements, such as systolic blood pressure and shock index.  The new study is titled, "Prehospital ETCO2 is predictive of death in intubated and non-intubated patients."  We discuss this study with her and what's next for this research.  We also touch on why prehospital providers should get involved with research.

Dr. Eric Campion is an attending trauma surgeon at Denver Health Medical Center in Denver, Colorado. He has several studies published on the utilization of End Tidal CO2 (ETCO2) in critically injured hemorrhagic shock patients.  As a former paramedic, Dr. Campion has also been studying this data's application to the prehospital setting.  In this episode we discuss the results of two specific studies which lead to his most recent study with Paramedic Courtney "Coco" Wham.  There will be a companion episode released later this month!

Dr. Spencer Tomberg, a physician in the Department of Emergency Medicine and Orthopedics at Denver Health, discusses pain management and the complex nature of pain perception, highlighting the physical and emotional components. He describes how individuals may have different perceptions of pain due to variations in the action potential and synaptic regions. He dives into the etiology and routes of pain signals from the visceral system and how that contributes to referred pain. He also discusses the differences in treatment when approaching acute, subacute, and chronic pain. Ultimately, it's important to consider the individuality of pain experiences when treating patients and not take a one size fits all approach. Check out another great lecture from the Rocky Mountain Trauma and Emergency Medicine Conference. See more from the blog post on our website at: https://emspodcast.com/pain-perception-is-complex/

In the high-stakes world of emergency medicine, innovations continually push the boundaries of what's possible. One such groundbreaking procedure is Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Dr. Ernest E Moore, who has literally written the book on trauma surgery, teaches us what REBOA is and how it is being used to save lives in critical situations. Another episode from the Rocky Mountain Trauma and Emergency Medicine Conference.  See more on this topic from the blog post on our website: https://emspodcast.com/resuscitative-endovascular-balloon-occlusion-of-the-aorta-reboa/  

Dr. Stacy Trent, an Associate Professor of Emergency Medicine at the Denver Health Emergency Department, discusses the importance of proper airway management in the emergency setting and introduces the mnemonic SOAPME (suction, oxygen, airway assessment, pharmacy and plan, monitor and equipment) for intubations. Dr. Trent brings with her the most up to date literature about optimizing success and decreasing adverse events during intubation. In this episode we delve deep into the often overlooked aspects of pre-oxygenation and airway assessment, emphasizing the need for thorough preparation and the potential consequences of neglecting these steps.

Is your EMS agency prepared for a pediatric disaster? In this episode of EMS CAST, Dr. Jeffrey Upperman joins the hosts live at the Rocky Mountain Trauma and Emergency Medicine Conference. Dr. Upperman gave an entertaining and engaging lecture on what you need to start thinking about to be prepared for a pediatric disaster in your area. After his lecture he joined our podcast to discuss his passion for pediatric disaster preparedness and the journey he has taken over the past 15 years to develop educational platforms in this area. There are some easy steps you can take to make sure that you and your crew are prepared should a disaster strike. Tune in to learn more about Dr. Upperman's work and the importance of being prepared for emergencies involving children. And check out some more great resources here - https://www.chla.org/trauma-program/pediatric-disaster-resource-and-training-center

Stop blowing off back pain patients! There may be a true emergency lurking underneath. Dr. Bo Burns teaches us why we should take atraumatic back pain so seriously. We're back with another episode from the RMTEMC. We dive deep into the topic of epidural abscesses and cauda equina. These are true spinal emergencies, so we should understand them. Our expert guest, Dr. Bo Burns shares valuable insights on how to recognize and diagnose, emphasizing the importance of a high index of suspicion. We also explore the role of pre-hospital providers in identifying at-risk patients and providing crucial information to the emergency department. Join us as we unravel the complexities of spinal emergencies and learn about the latest clinical decision tools and treatment options.    Blog post- https://emspodcast.com/spinal-emergencies-a-closer-look-at-back-pain/

In this episode of EMSCast, hosts Ross Orpet and Will Berry discuss a lecture given by Dr. David Bliss on taking care of pediatric trauma patients. Dr. Bliss emphasizes the importance of supporting the psychosocial needs of pediatric patients, as they may not have the same coping skills as adults. He also discusses the unique challenges of treating pediatric trauma patients, including the need for specialized equipment, medication errors, and issues with diagnosis and communication. Listeners are encouraged to follow EMSCast on Instagram and visit their website emspodcast.com for more educational content. https://emspodcast.com/taking-care-of-pediatric-trauma-patients-with-dr-david-bliss/  

Earlier this month Ross and Will visited the Rocky Mountain Trauma and Emergency Medicine Conference. In addition to trauma games and sim wars, there were so many great lectures and EMS Cast was lucky enough to get to interview some of the speakers about their talks. We are excited to get to bring some of this great content to our listeners. Dr. Maria Moreira tells us about the conference and then Ross and Will sit down with Trauma Critical Care Fellow Dr. Chelsea Horwood to learn all the ins and outs of ECMO in the trauma patient.  To see a list of this years lectures and events- https://web.cvent.com/event/591e0026-80af-42cb-a801-ae94dd363ed6/summary https://www.denverhealth.org/for-professionals/clinical-specialties/trauma/trauma-emergency-medicine-conference   To learn more about ECMO- https://www.elso.org/

American College of Surgeons just updated their prehospital trauma triage recommendations. Learn about what the updates mean for paramedics and EMTs and how you can practice this on everyday EMS calls. Link to Blog Post- https://emspodcast.com/trauma-triage-guidelines-update/ Link to ACS Trauma Triage Guidelines- https://www.facs.org/quality-programs/trauma/systems/field-triage-guidelines/  

Pharmacist, Kevin Kaucher, joins us to discuss the ins and outs of nitro in acute coronary syndrome. Does it work? Is sublingual better than paste? Can it be dangerous? Come learn the latest on nitroglycerin.  For more info and to see the EKGs from the case: https://emspodcast.com/the-truth-about-nitro-separating-fact-from-fiction/