EMTpro Podcast

In this episode, Steve, Dan, and Holly are back in the studio as Holly leads the team through an in-depth discussion on the trauma death triad (diamond). Holly provides a scientific breakdown of each component, and then the team discusses the practical implications of each component in the “real-life” management of a trauma patient in the field. 

In this episode, Steve, Dan, and Holly are joined by guest Matt Shamrell, a burn unit ICU nurse.

Steve and Dan co-host their first show without Holly as they welcome special guest Eric Jaeger. Eric is an RSI Paramedic and Attorney from New Hampshire who leads the discussion on best practices for physical restraint and chemical sedation and the legal ramifications these interventions carry. Eric shares his knowledge of the tragic circumstances surrounding George Floyd and Elijah McClain's deaths and discusses improvements to consider when it comes to protocols and guidelines for these procedures.

In today's episode, Steve, Dan, and Holly have the opportunity to discuss an interesting MCI call with guest, Firefighter/Paramedic Kyle Snider. At the time of the incident, Kyle was a new paramedic graduate with wilderness medicine training who was working in a rural department with limited resources. Kyle discusses the call from the point of dispatch to call completion and reviews what he felt went well and what he would have changed.

In this episode, Holly talks about a new program she is helping head, whose goal is to provide treatment to patients suffering from opioid addiction.

In this follow-up episode, Bruce and the team continue their discussion on ventilation and airway management. This episode goes into much greater depth on how ETCO2 can be used to manage an array of patients effectively and how a thorough understanding and monitoring of end-tidal during a resuscitation attempt can help ensure a patient remains neurologically intact, assuming ROSC is achieved.

In this episode, Steve, Dan, and Holly talk with Bruce Opsal, a long-time firefighter and paramedic who has spent years leading training programs centered on effective airway management and ventilation. Bruce first emphasizes the importance of airway management in any patient, especially those in cardiac arrest.

This episode demonstrates the importance of history gathering and provides a deeper insight into lab values and how they are used to diagnose patients with less obvious disease processes. Listeners should walk away feeling better equipped to identify both endocrine and electrolyte imbalances in patients with unique presentations.

In this episode, Steve presents two trauma case studies for the group to discuss. While patient care in both of these calls went well, and these scenarios provide an overview of successful extrication and patient management following both an MVA and significant blunt force trauma, the distinguishing factor in each is a very specific element that caught Steve "off guard" and forced him to revisit the call days or weeks later.

In today's episode, the team talks with Daniel Sundahl, a 20-year Firefighter/Paramedic, and artist. Daniel discusses how his experiences navigating PTSD led him to create powerful artwork, which is now helping open the conversation around mental health for first responders.

In this episode, Steve, Dan, Holly, and Dr. Selbak review a few of their calls involving aortic dissections. Because aortic dissection is a relatively uncommon disease process, and many severe cases never make it to the hospital, reviewing these cases provides a unique opportunity for the listener to gather abundant knowledge in one sitting that may otherwise take years to gather in the field.

In this episode, Steve, Dan, and Holly talk with Dr. Ramsey Selbak about the increasing prevalence of violence in healthcare. They each take a turn providing examples of dangerous situations they've been involved in, how they handled them, and how they have adjusted their tactics as providers since. This episode introduces a much-needed conversation about provider safety in healthcare and how it has long been neglected. The team touches on why violent incidents seem to be more commonplace, why they often go unreported, and the lack of debriefing many EMS providers have following these events.

In this episode, the team discusses specific ways efficiency can be improved in the field of EMS. The team discusses cardiac arrest response, checklists, and managing equipment on chaotic scenes. This episode encourages all providers to think critically about how we can each advocate for change that has the potential to dramatically improve patient outcomes.

In this episode, Steve, Dan, and Holly have the opportunity to chat with Dr. Selbak in the studio. Dr. Selbak introduces an exciting case he came across while working in the emergency department and discusses with the team how he went about treating it.

In this episode, Steve, Dan, and Holly discuss their experiences with OB calls, specifically field deliveries, that were outside a typical “textbook” experience. They dive into the aspects of the scene, patient, transport, and crew to discuss what made their experiences stand out. Each provider will also take the time to address a unique OB emergency related to the patient in their story or that they have experienced and how they treated that patient to benefit both mom and baby.  OB calls, specifically those in which deliveries are imminent, are low frequency with the potential to be very high risk. So the team discusses how they felt going into the call, what they did that helped set them up for success, and what about the scene created a roadblock as they attempted to provide the best possible patient care.  While each patient discussed delivered otherwise healthy babies, listener discretion is advised as these stories involve less-than-ideal scenarios with challenges in both patient care and scene management. 

In this special episode, we celebrate our co-host, Dan Livengood, on his retirement after 27 years in the fire and EMS service. Dan is one of the most selfless and caring people you'd ever hope to have show up at your door during your time of need. We learn from his co-workers just how much fun it was to work with Dan and what life in the firehouse with him was like. 

In this episode, Steve, Dan, and Holly discuss EMS education with Adam Culbertson, a current educator in North Carolina. The team has the opportunity to ask Adam about EMS education and how it is changing, as well as some trends we can expect to see in the coming years.

In this episode, Steve, Dan, and Holly are joined by Dr. Ramsey Selbak, EMTprep's Physician Advisor. Dr. Ramsey discusses his background in emergency medicine as well as his experience and relationship with field providers. The team then delves into an age old rut into which many EMS providers fall - chasing numbers. What do we mean by this?  Trying to correct specific lab values or vitals without taking into account the entirety patient. What do they look like? Why might this vital or value be skewed? How long did it take the patient to get to where they are now? And, of course, is the patient stable as they sit? Dr. Ramsey provides a couple brief examples of times where seemingly critical patients remain stable with limited intervention in the ED, which implores the crew to discuss the role of EMS providers in the field, and re-evaluate their responsibility to "fix" or "reverse" patients with advanced disease processes.

In this episode, Steve, Dan, and Holly discuss calls that are not "black and white", and have forced them to think outside the box. Steve provides Dan and Holly with a case he encountered and has them walk through their decision making. He then reflects on how he and his crew responded to the scenario. Holly reviews a call she had that presented a variety of challenges and forced her to work in the "gray zone" and defend clinical decisions she made. The team closes by reviewing the importance of critical thinking and its application in the world of emergency medicine. 

Steve, Dan, and Holly are back in the studio after a 6-month hiatus. The team reviews disaster medicine, how to get in the door, and what to expect on deployments. Dan Livengood is interviewed and discussed his multiple deployments that started in 2001 in El Salvador up to his most recent deployment to Ukraine. 

Steve is back in the studio to give you a quick update on our friend and guest, Debbie Bailey. Steve gives a timeline for when the trio will be back in the studio again to record the next episodes of the show. 

Steve, Dan, and Holly bring special guest Debbie Bailey on the show to discuss the process of dying and death itself. The trio listen as Debbie describes her battle with a terminal illness and what her recommendations are for EMS providers who are called to treat those in their final days and moments. 

Steve, Dan, and Holly bring in Dr. Ramsey Selbak to discuss Ketamine use from an ER Physician's perspective. In addition to some case reviews, key aspects of Ketamine dosing, indications, and side effects are discussed. 

Steve, Dan, and Holly bring Nate and Andrea from the Guardian Group into the studio to discuss Sex Trafficking Awareness. As EMS providers, Nate and Andrea walk listeners through what to look for on scene, best practices when you find evidence of trafficking, and how to protect your loved ones at home. 

Steve, Dan, and Holly discuss the background and use of Ketamine in EMS. The trio interviews their guest, Oregon Firefighter/Paramedic Isaiah Burkhart, an Army Ranger veteran, about his experience with Ketamine personally and professionally. Various calls are discussed outlining what went well and what could have gone better when it comes to chemical restraint. Various doses and indications for the drug are discussed along with what the future of Ketamine use could look like in depression and psychotherapy treatment modalities. 

Steve, Dan, and Holly are joined by Dr. Ed Racht to discuss humor and its role in EMS. Gallows humor is discussed as well as the concept of looking at humor as a different language for EMS providers. Dr. Racht reviews when to know you've crossed the line and how to test your humor out with your co-workers, friends, and family if you're unsure if it will be received well. 

Steve, Dan, and Holly are joined with their colleague Chad who works full time in human trafficking in the Portland area. Chad describes his work, defines trafficking for listeners, and outlines what EMS providers can do when their "spidey senses" are going off.  Mental health awareness is discussed when it comes to first responders who are constantly faced with gut-wrenching calls and cases. Steve and Dan discuss calls where they felt something was off and took various actions which may have helped get their patients the resources they needed. 

Steve, Dan, and Holly discuss the fundamental differences and pros and cons between private ambulance EMS and Fire-Based EMS. The trio is joined by two Firefighter Paramedics from Washington State - Eric Chamberlain and Jeff Wright, who have a unique outlook on EMS compared to the average of their peers. 

Steve, Dan, and Holly return to discuss the generational gaps in EMS and the workforce in general. The trio talks about the common stereotypes and strengths of Baby Boomers, Gen X, Xennials, Millenials, and Gen Z. The trio details their own personal experiences working with people across all generations and how those differences can make work fun. The differences between millennials and the other generations in the workplace are examined. 

Steve, Dan, and Holly are back after an extended hiatus due to COVID-19. Listen as the trio discuss how COVID has impacted their lives both professionally and personally.  Compassion fatigue and the impact of the Coronavirus on healthcare workers across multiple disciplines are discussed. Steve discusses one of his recent COVID-related cardiac arrest calls and the changes EMS is facing in the waking of the pandemic. 

Steve, Dan, and Holly return to discuss the pathway to a successful internship. The trio talks about how formative internship is for students and begin answering questions submitted by prospective students. The trio details the stress of the first day of internship, and what students can expect. Adaptation is key; different agencies operate differently and have their own unique challenges. Steve reminisces about his internship, and how the system he worked in operated. Holly, Dan, and Steve each give their number one tip for success during the internship. The importance of attitude is discussed, as well as being open to learning from professionals with years of experience. To wrap up the podcast, the trio discusses common issues paramedics can run into, and the importance of self-care.

Dan, Holly, and Steve return to discuss resiliency and its importance in emergency medical services. Dan and Holly open by highlighting their attendance at the Train the Trainer course for the FBI Officer Resiliency course. Holly and Dan further detail the organizational components of their course, and its emphasis on teaching resiliency early. Story-telling was focused on in the course, as a way to help everyone open up. Holly and Dan review the science behind dealing with stress and building resiliency. Setting goals that correspond with one’s values will make reaching those goals easier. The trio calls Scott, a fire chief from Texas, who recounts a story about finding peace and appreciating our individual journeys. The group highlights the importance of practicing gratitude. The trio wrap up the podcast reflecting on the material discussed in the FBI Officer Resiliency course, and how they apply the philosophies outlined into their own lives. 

Steve, Dan, and Holly are joined by a special guest, Dr. Brenda Tillman of Readiness Group, to discuss how we as first responders can deal with chronic stress. In today's world of Covid, natural disasters, social unrest, and political division, it's hard to maintain our sanity when you throw in a stressful job on top of it. Dr. Tillman reviews ways we can practice good self-care to stay sane and improve our resilience. 

In this episode, Steve, Dan, and Holly discuss lung sounds, their treatment modalities, and common misconceptions. Steve leads a Lung Sound recognition game while Dan and Holly square off to see who's the best. After listening to the lung sound, they then discuss the correct sound by reviewing the textbook definition of it and the treatment options for it in the field.

In this episode, Steve, Dan, and Holly talk about cardiac arrest response with the EMS coordinator at Rialto Fire, Joe Powell. After looking at Rialto Fire departments stats, Joe realized they had to do something different. At Rialto Fire, they have committed to the  ‘wheel of survival’ which is a regularly evolving set of steps designed to maximize the interventions of EMS personnel with their patients who are experiencing cardiac arrest. Their stats on cardiac survivability have improved significantly since implementing this and they have multiple studies published in JEMS.

Steve, Dan, and Holly introduce Scotty Bolleter, one of the co-inventors of the EZ-IO. Scotty details how he got started in EMS, and what led him to help create the EZ-IO. Scotty discusses his time as a flight paramedic, and how his time spent training in hospitals pushed him into EMS business ventures. Steve touches on his business ventures in EMS. Scotty walks the trio through his team’s process of modifying older devices to create their version of the EZ-IO. Scotty talks about his inter-disciplinary team of physicians, engineers, and others. The correct process of placing a humeral IO is discussed, from positioning the patient to proper placement for insertion. The process of IO flow is explained. Scotty discusses possible complications if an IO is placed wrong. Scotty discusses the use of the distal femur IO placement in cardiac arrest at his department. IO placement in the femur versus the humerus or the tibia is compared. Pediatric IO placement is reviewed. Scotty highlights the open IO, and when it is indicated. Correct IO placement is recapped, and Scotty touches on why EMS providers should not bury an IO needle into the bone. Steve reviews a call on a patient in status seizure where an IO is used for access.

Steve, Dan, and Holly introduce their guest speaker, Kari, a respiratory therapist/paramedic from Washington. Kari discusses the endotracheal tube and the importance of having a correctly sized and placed tube. Kari highlights how critical it is to understand the disease processes that resulted in the patient being intubated. Ventilation and oxygenation issues are reviewed, along with the importance of PEEP in intubated patients. Kari talks about PEEP in intubated patients with asthma or COPD, as well as variations in tidal volume settings for various disease processes. The group discusses minute volume, and how a patient’s minute volume is calculated on the ventilator. Kari discusses her process of titrating ventilator settings to meet a CO2 goal. Do no harm is reviewed in relation to mechanical ventilation, and the consequences of a patient working against the ventilator are discussed. Assist control (AC) and synchronous intermittent mandatory ventilation (SIMV) modes are compared. Kari details what modes she prefers for specific patient presentations and disease processes. The group discusses volume and pressure control, and review a trauma scenario where the patient is intubated. Peak inspiratory pressure and peak alveolar pressure are reviewed, along with what abnormal values can indicate. The importance of driving pressure is highlighted. The PF ratio is discussed, along with the importance of weaning patients off of 100% FiO2. The group ends on discussing appropriate IE ratios in obstructive patients. The flow rate in both volume and pressure control is reviewed, as well as the effect of flow rate on a patient in both volume and pressure control settings. Another scenario is discussed, a COPD patient that has been intubated. Kari walks through troubleshooting tactics for ventilators and potential fixes for common issues with mechanical ventilators.

Steve, Dan, and Holly introduce themselves, and today’s focus, trauma. Steve reviews his educational background, and how his university set him up for success in paramedicine. He then transitions into his craziest trauma call, dispatched a potential stabbing. Walking into the scene, Steve sees his patient, a 20-something-year-old who has been stabbed two times in the chest and once left arm. The crew bandages the superficial bleeding chest laceration, and places and tourniquet on the left arm laceration. When the patient loses consciousness, Steve has to act quickly to handle a tension pneumothorax. Steve, Dan, and Holly discuss the sequence of assessing a trauma patient. The physiological process of a tension pneumothorax is reviewed. The trio discusses what signs and symptoms indicate the need for a needle decompression in the field. Proper placement of the needle during a chest decompression is outlined. Holly sheds some light on what occurs in the hospital after a patient is dropped off with a decompressed tension pneumothorax. Dan details his craziest trauma call, which began on the way to a public education event. Enroute, Dan and his partner receive a call, a GSW to the face. The team performs a surgical cricothyroidotomy on scene in order to establish a patent airway. Dan discusses his thought process on the call and outlines his preferred method of performing a surgical cricothyroidotomy. Dan, Holly, and Steve review surgical cricothyroidotomy. Holly talks about her trauma call, which began as a search and assist on a mountain top. After assistance from a local volunteer firefighter, Holly and her partner arrive on scene to a single-vehicle MVC off the side of a cliffside. Five patients are present, three alive and two deceased. Holly describes the scene, and discusses challenges to care.

Steve, Holly, and Dan are back with Dr. Brenda Tillman and Ben Wescott in part two of their PTSI series. Dr. Tillman emphasizes how important it is for senior providers to encourage open discussions on mental health. Ben shares his insight on how providers can challenge the stigma of discussing mental health. Ben shares his story and highlights his path to healing. Dr. Tillman and Ben discuss peer support groups and educating departments on PTSI and PTSD symptoms and prevention. Steve, Holly, and Dan field questions to Dr. Tillman and Ben. Dr. Tillman outlines ways departments can implement peer support groups.

Steve, Dan, and Holly introduce Dr. Brenda Tillman and Ben Wescott in their seventh podcast. Dr. Tillman discusses her experience as a clinician, and Ben introduces himself. Dr. Tillman details the difference between PTSD and PTSI, and why those differences are important when diagnosing first responders. Counseling programs for first responders are overviewed, as well as the training process for counselors counseling first responders. Dr. Tillman reviews the process of EMDR and why it is effective for improving symptoms of PTSI and PTSD. The physiological effects of PTSD and PTSI are detailed. Steve talks about his experience with EMDR. Coping mechanisms in first responders are debated. Dr. Tillman talks about the importance of normalizing the symptoms of PTSI in first responders, and why peer support group and counseling is so essential.

Steve, Holly, and Dan begin their sixth podcast discussing the difference between PTSD and PTSI. Steve touches on his journey with PTSI. The initial triggering call is reviewed, and Steve details the emotional and physiological symptoms he dealt with. Steve talks about his experience with counseling. The trio overview common emotional and physiological symptoms of PTSI, as well as behaviors that can manifest from it. They describe the difference between debriefing and defusing. The importance of emergency medical responders taking care of themselves is highlighted.

Steve, Dan, and Holly begin their fifth podcast with a case study on a motorcycle accident. Dan describes the logistics of the call and initial patient presentation. Mistakes made during rapid sequence intubation are discussed. The trio talks about the evolution of airway management procedures, such as the process of intubating patients and pre-oxygenation. Dan discusses his checklist for successful rapid sequence intubation. Steve reviews his checklist, along with his triggers for backup airway placement and cricothyrotomy. Holly recaps a call where she decided against intubation and describes her thought process.

Steve outlines his “craziest” cardiac call for Holly and Dan, which was dispatched as a person down. He discusses logistical issues affecting patient care, and how those issues were addressed. Steve, Dan, and Holly review the call and talk about lessons learned. Dan breaks down his “crazy” cardiac call for Holly and Steve, which was dispatched as a cardiac arrest. The three review patient care rendered prior to arrival and patient care performed by Dan and his team. Lessons learned are discussed.

Holly talks about her background as a paramedic and flight nurse. Dan discusses certifications he obtained to become a flight paramedic. Holly discusses her path to become a flight nurse. The trio outlines similarities in protocols for flying a critical patient in the field. Holly touches on the importance of flying patients with time-sensitive presentations, be it medical or trauma-related. Dan and Holly describe their typical day, and what their crew and individual agencies look like. The two talk logistics when responding to a scene call in the helicopter. The influence of weather on flying is discussed, and Holly goes over the limitations of IFR and VFR aircraft. Ground contact protocol and communication between ground units and the flight team are overviewed. Steve reviews a call from his agency and fields Holly and Dan some questions regarding logistics and patient care.

In their second podcast, Dan and Steve discuss what their individual departments have done in response to COVID-19. Current statistics regarding the novel coronavirus are reviewed. Dan walks through what a call at his agency looks like in the midst of the COVID-19 pandemic. Steve touches on how COVID-19 has changed how departments respond to calls, as well as the mindset of medical providers on scene, exposure protocols, and PPE requirements. Steve discusses a call where proper PPE prevented him from having a life-threatening exposure. Dan outlines a breathing problem call at a care facility and the process of intubating a patient in respiratory failure. Dan details his decision to withhold intubation on a rapidly declining patient, and what backup airway he prefers to use in lieu of an ET tube. Steve and Dan talk about quarantine procedures for their agencies following exposure to COVID-19.

Steve and Dan review their goals for this new podcast and how you can obtain your CE hours through EMT-CE.com. After the introductions, Steve and Dan dive into some interesting case reviews regarding airway management and trauma.