Practical EMS

Bryan Jepson MD and CFP, author of The Physician's Path to True Wealth: 12 steps to gaining control over your money and your time – you can find it on Amazon and at this website for free Bryan Jepson MD, CFP® | physician financeDisclaimers:This is not specific financial advice, this is general education. Talk with your own advisor or schedule with Bryan to get specific advice The earlier you can get financially literate and work on a plan the betterBryan is an emergency medicine physician, along his journey in medicine he also spent 5 years working in Autism before coming back to EM full timeThe covid pandemic and a feeling of stagnation and desire to keep learning prompted Bryan to pursue a master's degree in finance Bryan finds familiarity in his role as a physician to his role as a financial planner. You listen to the client and come up with a plan that fits their needsBryan talks about the difference between riches and wealth; discretionary income is the income above your mandatory expenses – and what you do with that extra income is how you become wealthy or richRiches are the material things you may spend that money on, car, house, toysWealth is the money you could spend but instead save or invest insteadThe goal is to create assets so that your income is no longer needed. Buying back your timeWhen you have true wealth, you can make decisions with your timeWorking towards being financially independent prevents burnoutChoosing to work vs working because you have to is easier, and makes you a better providerKey attributes to develop to be financially successful: Be patient – assets grow slowly. Be consistent in investing. It is boring. Be honest with what you know and what you don't know so you can spend some time educating yourself. Courage, because it does take some risk taking to invest instead of just savingIf you keep all your money in cash, you are guaranteed to lose purchasing powerThe longer your time frame the better the stock market will perform for youCreating discretionary income is difficult at lower incomes levels. But I do still believe you can retire from EMS. One way that I was able to save and invest as a paramedic was working overtimeHaving higher incomes does speed things along but it is not the cure for financial problems because we all have a tendency to spend what we make – fundamentally it's the same problemWe talk about the vehicles we drive and how we have utilized them to save more moneyBut spend money on Support the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

We need to remember that paramedic and EMT's are solely focused on emergency medicine vs RN's or even PA's who are trained in general medicine then learn how to do EM later onLearning sick vs not sick is a skill that develops with time, it's not always easyGestalt can be an important factor in your assessment but don't trust it all the time, it can lead you astrayA negative work-up does not always mean there isn't something dangerous going onRecognizing your biases will help protect you from making a mistake or overlooking somethingAdvice for the newbies:Have humility when you are new, be willing to be taughtNever stop learningBe proud when you do perform wellDon't trust your gestalt when you are new. Take every patient seriouslyKeep a journalBe honest, do what you document and document what you do, admit your mistakes quicklyTaking ownership over mistakes helps you learn and gives you more respect than passing the buckThe call you are going to is the call you are supposed to go to. That is where you are meant to go. No patient is a waste of time. That patient deserves your undivided attention Too many people hear the other exciting calls dropping nearby and they become distracted from what they are currently doingPeople are put in your path for a reasonAlex talks about a night he ran 3 GSW's and had to use good coping skills to recoverSometimes the lower acuity patients can rejuvenate youRunning only high acuity will burn you out too, take some joy in the less stressful callsAppreciate the highs and lowsSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

How do we have long careers and avoid burnout?Micah talks about burnout and how we have the advantage in emergency medicine that we can leave work at work and step backHave time off and don't work overtime every time an opportunity arises, don't only discuss work with your spouse, have other interests that you can engage inEmergency medicine is a fun job to identify with because we get to save lives, but you should not make it your whole personalityFind an identity outside of work, you may not have work at some point and life changesAudrianna talks about taking care of yourself. As we spend so much time being empathetic for others, we can lose that empathy for family or even ourselvesWe talk about the lower acuity patients we care for and infrastructure to take care of their complaint quickly from the ED, patients have poor access to primary care, and we can be that solutionWe can't use low acuity calls as something that burns us out or allows us to get frustrated, it will always be part of the job and we should view it as us being the solutionWe can be educators, we are trained to recognize emergencies, the layperson shouldn't be expected to know thisWe have the privilege of taking care of everyone regardless of complaint, ability to pay, social statusBurnout begets burnoutTake the time off when you need it, overtime takes more from you than it may be worthCertain seasons of life may necessitate working more but you have to understand the cost benefitJust making it through COVID is a victory, it burned a lot of providers out, even those with experienceWe recount some of our COVID war storiesSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

How do we handle the sensitive hand-off reports from EMS to the ED?Different aspects, like potentially violent family members, unsafe scenes, are often a critical details that need to be conveyed to the ED but don't have to be announced to everyone in the hand-off report in front of the patientMicah works as a field and ER paramedic. He talks about this situation and how it's going for him. He enjoys the number of resources he has access to in the EDBeing able to see the whole workup and outcome of the patient is a big benefit as well, working in the EDI love it when the EMS crews come back and follow up on their patients, it's a big way to help them improve and learnWe talk about interpersonal conflict on scenesCasey tries to be as friendly as he can and learn everyone's namesIt's easy for all of us to allow our egos to get too out of hand, but we need to treat everyone how we would want to be treatedI talk about some issues I've had with the fire department in the past – sometimes it is all about how you are doing something as opposed to what you are doing in your interactions with other agenciesAt the end of the day, the patient can be affected when we have confrontational scenes so we should always be seeking to avoid thisAlex talks about working 48 hours with his fire crew and responding on scenes with the same crew and how this differs from private ambulance responding with other agencies he may not know very wellCasey talks about how, years ago, the EMS crews had more time to stop by the fire stations and become more familiar with the fire crewsCasey talks about the power of edifying others in our fieldAudrianna talks about a fire crew going above and beyond in the ED as wellWe talk about small things we can all do to go above and beyond our regular tasks, helping families navigate the ED, getting a blanket for someone, cleaning a roomLittle things like this also help you feel better about your job too; they help you remember why you got into medicine in the first placeIt does require you to look beyond yourself to see those opportunitiesSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

New panel with Audrianna (RN), Alex (paramedic), Casey (paramedic) and Micah (paramedic)What do the ER nurses like to get in the hand-off report from EMS?Audrianna likes to hear clear, concise reports. How ambulatory was the patient on scene? Casey recalls from years ago how the ER nurses didn't understand enough about what EMS did, that always made giving reports more difficult and how that has improved over the yearsI always try and give new EMT's the freedom to struggle through giving reports so they can practice and improve without cutting them off or making them feel rushedGiving report is a difficult aspect of the job, especially when it's a critical trauma patient and you are giving report to a room full of peopleIt's easy to get in a rush to move the patient over, but we need to give EMS the time to give report - It's a big part of our day that allows us to build the team rapport between EMS and the EDAlex talks about the perspective going from a busy private ambulance to a slower county system We talk about differences in nurse workload vs paramedic in the fieldSometimes EMS doesn't fully understand some of the nuances of how and what we use their IV's for in the EDAudrianna talks about how ER nurses are trying to maximize their time while getting report from EMSED charting is a lot more complicated than the fieldI talk about how seeing ambulances when they arrive should be the highest priority for a providerMicah talks about the limits of our ability to obtain accurate information in the field many timesSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Some ambulance crews may not have the best understanding of how a fire crew is going to run a call, with everyone assigned specific roles – often the fire department will be allowing a new crew member to lead the callI always struggled with arriving first on scene on the ambulance because that role is more work and more pressure What does fire like from the ambulance crews when they arrive first?First on scene should be allowed to lead the call and ask for help where needed, second on scene should not be pushing their way in and trying to take over the callSometimes the providers that take over lack experience or are not yet comfortable enough with their own skills to allow someone else to leadIf you have another provider on scene constantly trying to interrupt, give them something to do - often this applies to a disruptive family memberDoes the ambulance paramedic have to attend in the back if the fire paramedic rides in?As a previous ambulance paramedic, I viewed the ambulance as my space, meaning I always appreciated it when the fire paramedic had the respect to treat it as such, asking to ride into the hospital as opposed to telling me they were riding in. As a general rule, if the fire paramedic believes they need to ride in due to acuity, the ambulance paramedic should also attendKash, as a medical director, gives his opinion on this situationI really appreciated it when the fire crews respected our ambulance because the front is truly our officeEMT's can ride in too on low acuity where more hands, not ALS treatment, is neededI've talked before that a paradigm shift is needed for the paramedics at times, where they are more likely to have to attend more calls then their EMT partners -  easy for me to say from outside the field now – but transporting the patient is almost always the safest, lowest liability option, we shouldn't be trying to get out of transports just because it's less workAlways treat the patient like they are a family memberWe are looking for proof that the patient is not sick, as opposed to assuming they are not sick from the outset, our approach is different in emergency medicineWe have, historically, reversed hypoglycemia or opiate OD, and the patient has refused when maybe transport to the hospital is warranted despite the fact that we have temporarily fixed a major problemSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

How do we have successful, long careers in EMS?John recommends living away from where you work, doing unrelated activities outside of work so your life doesn't revolve around work thingsTaking care of someone you know is an odd position to be in, it can mess with your ability to be objectiveJason says we need to have an awareness of how we are feeling and how those around us are feeling, therapy is always a great option, get outsideThose of us in EMS/fire do deal with a level of PTSDTerry talks about this in his own life, when he broke down and started crying without an obvious reasonPTSD is not a lack of desire to cope nor is it a sign of weaknessKash talks about burnout vs moral injuryBurnout tends to blame the individual vs moral injury blames the system we work inI don't disagree that the systems we work in are imperfect and moral injury exists, but I still like the term burnout because, no one is coming to save us, the responsibility is on the individual to overcomeBurnout can slowly occur to the degree that you don't even realize right away what is happeningIs burnout inevitable?Kash says that moral injury is inevitable in some form or another - the important thing is to recognize it and deciding what to do about it, take actionAcute vs chronic burnout requires different solutions as wellKash recounts the Covid effects on EMSTerry talks about the ability to acknowledge your struggles and continue to move on and live your life, in spite of themI asked Jason about his decision to stay a fire paramedic instead of promoting up the chain, he didn't want to promote just for the money, he would rather have passion for it. He is still very passionate about practicing medicine as a paramedic and enjoys his career as it isHow do we get along on scene when responding with multiple agencies, fire vs private ambulanceJason talks about how beneficial it has been to see both sides, you can have more compassion for the other side when you see their strugglesHave the right attitude approaching a scene, work to get along with others as best you can despite the strong personalities we all tend to haveSometimes a short conversation goes a long way. Having ambulance crews stop by the fire station for some food or short hang-out can also dramatically improve your relationshipWe tend to assign ill-intent when we don't know someone, vs good intent when we do know themIt is difficult to fully understand each other's roles, when you aren't doing that job on a daily basis, trauma bonding calls can be helpful when you get into thSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Our system has made access to EMS trained medical directors much easier, which is a huge benefit to the crewsThe EMS fellowship for MD's tends to attract those that are interested in helping EMS because they are passionate about it and not in it for the moneyWe are always trying to give EMS the amount of time they deserve when giving reports from the ER sideKash talks about his technique in getting a good report from EMS on the higher acuity sideEvery provider has slightly different preferences on how much information they like to get from EMS, Kash talks about his ideal EMS reportI really like the crews to lead with the chief complaint so I can understand how pertinent the rest of the report isWe talked about the previous culture on contacting medical control and how this has changed over timeWhat does retirement from EMS/fire look like?Terry's retirement came suddenly after an injury, which made it difficult as he wasn't expecting itTerry still remembers the calls he has run around town, the intersections, he says the bad memories have tended to get better over time. He recommends finding something else to do in retirement, keeping busy. Don't get stuck in the past recounting call after call. It can be difficult to give up the comradery you have at the fire departmentWe talk about the terrible question “What is the worst thing you've ever seen?” that we frequently getIt forces us to recount those horrific callsThe person asking the question is not mentally prepared to hear the answerI talk about the difference dealing with tragedy in the ER vs the fieldSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

New panel: Fire officer/paramedic John, fire paramedic Jason, retired fire paramedic Terry and EMS medical director KashHow to determine capacity and how this differs from competency This becomes critical when doing refusals – when the patient decides not to be transported – a very high liability part of EMSThis is different than AAOX4Capacity is very situational and specific, competency is determined by a judgeWe determine capacity:They must communicate a clear choice, an understanding of their current situation, understanding the risks and benefits of refusing or accepting careSuicidal thoughts mean the patient does not have the capacity to makes decisions for that particular aspect of their careBack when I first started in EMS, we would routinely force a suicidal patient to go to the hospital. The current culture puts EMS crew safety as a higher priority. Meaning, if we don't have the support of law enforcement, we are not going to force patients against their will to get a mental health evaluationWe talk about our relationship and reliance on our mental health evaluatorsDocumenting these difficult cases involving suicidality and capacity can be toughOne of the current challenges is assuring cooperation between EMS and PD to help safely transport a patient with suicidality but that is also a potential danger to providersInvolving medical control is critical in these difficult situations, especially with technological changes decreasing the difficultyWhen in doubt, just make the consult EMS trained physicians improve our ability to do our jobs as more and more emergency medicine physicians get this training, it can only benefit usSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

The difficult admissions are the generally weak, unable to walk with no acute findings. They typically do not uncover any acute findings while in the hospitalIn the ED, we can probably do a better job of involving some of our resources like social work to really give the patient and their family a better understanding of what admission will and won't accomplish for themPart of the America culture does put us in unique situations as the elderly often do not live with their children anymore. Family live far apart and often cannot help each other when in needNo one blames the patient for the situation they are in, but we want to find the best solution to serve themIM deals with the limitations of insurance much more than we do in the EDUltimately, each hospital group needs to establish a culture. What would you want done for your Grandma?A little more work now on these difficult cases in the ED can have the downstream benefit of keeping admission beds open for your next shiftDementia patients with progression of their disease process can be tricky to disposition as wellWe don't do the best job in our society of talking about the normal aging process and how to preserve our patient's dignity and sense of self in that processWe are scared to death of deathWhat is the difference between Observation admission and Inpatient admission? The care is the same regardless of the admission typeAn observation admission is best thought of as a problem that could likely be handled in the outpatient setting if the patient had unfettered access to follow up to PCP and specialistsIn-patient implies that they need resources only found in the hospitalIn-patient vs obs can change over time, if nothing new is found, these statuses can changeSean recommends the book Same As Ever by Morgan Housel He talks about the changes in medicine being so gradual that they don't make headlines, but they are dramatic over time none the lessSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

EM and IM physicians don't get a great insight into each other's careers in medical school or in residencyDo hospitalists like doing consults as opposed to just taking admission requests?Sean says, yes, because it gives us an opportunity to solve problems together. They want to be consulted as much as possible Admissions would be greatly decreased if there was more robust outpatient follow up ability but various factors make this difficult Sometimes a slight delay in coordinating with the hospitalist or social work etc can save an admission and therefore free up ER beds down the line Not every conversation with the IM physician must be an admission requestWhen they are consulted, the expectation is that they put in a consultation note and see the patientLooking at an admission as trying to “sell” something is the wrong way to look at it. If you have a clear story and objective data, you should be able to articulate why they need admission most of the timeWhat does the day look like for a hospitalist?Admissions for our team are very easy early in the morning but rapidly ramp up during the afternoonThe admitting physician handles ER admissions, outside transfer direct admissions and ICU transfers to floor bedsSean goes into some detail about the workflow and what his day looks likeWhat are the difficult admissions to handle?We talk about one of the most difficult admissions we commonly see: An elderly patient with weakness, unable to walk but no acute findingsWe talk through possible solutions to better care for these difficult casesSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

New panel with Adam and Sean. Emergency and IM medicine physicians There is a study from 2023 called Battles to Burnout. Studying the role of inter-physician conflict in burnout. Primarily the conflict between emergency physicians and internal medicine physicians. A better relationship leads to less burnoutSean moved from primary care to hospitalist medicine when COVID was at its peakAdam, EM physician, returns to the showSean enjoys solving problems and that is what drew him to IM and hospitalist medicine, he did a 3-year residencyHe brings up an important distinction of our mindsets in patient care. In the ED we are looking more to find the problem, but he looks to solve the problem in the hospitalIn some ways, in the ED, we are a glorified triage. But more importantly, we are expected to be the second best in every specialty - the second best cardiologist, second best GI etcWe do still do a lot of problem solving in the ED as well, but we usually do have the skill of a lower cognitive switching cost, we can move between tasks quicklyWe to have to take efficiency into considerationSean talks about the superpower of IM being storytelling – one of his struggles is finding the best story to explain to everyone involved what is going on with the patient – sometimes the ED does not give the best storyWe need to help start the right story to help the IM physician on the back end to set them up for successOur limitations using a text platform to communicate does make it hard to read the intent behind questionsWith admission requests, Sean likes to hear what we think is going on. Not just a bunch of data points but rather the start of that storySean also likes to hear the chief complaint first, similar to what I like from our EMS crewsA 5- or 6-line paragraph max is sufficient, they start to worry when the paragraph gets longer that we either don't know what's going on or so much is going on its going to be a difficult caseAs APP's we don't get a ton of training in admission request story telling so it's an art we have to developAn admission request is a great time to slow down and really think about all the detailsBeing an ER APP can be a difficult position when working as a team with a physician. We tend to adapt to the physician we are working with. We share tasks and sometimes don't get all the same details on a given patientPatient hand-offs are a big source of information loss and errors. We can tend to turn patient stories into a game of telephone in the ED before the story even gets to the hospitalistSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

A difficult aspect of the job is the poor understanding of the public of what we do in EMS, and the poor understanding that our non-EMS friends and family have of what we doThose of us in EMS can understand each other better, we have seen the same tragedy and struggled with the same difficulties that are so hard to articulateWhat does retirement look like from a career paramedic in EMS?Casey struggles with this, it's hard to think about not caring for patients anymore. The closer he gets to retirement, the more it looks a little less clear what that looks like exactlyEddie isn't planning retirement soon so he can help provide for his kids. He does have retirement investments and fire benefitsAdvice for newbies in EMS:If you are seeing warning signs of burnout, get counseling immediately. Don't write it off or try to ignore it as normalEddie would not have tried to fight the warning signs of PTSD, he would have sought help much soonerHe did struggle with suicidal thoughts for a period of time – counseling was the solution. Sleep deprivation was a major factor in these thoughts for himHe had a breaking point where he felt ready to end his life – a counselor called him back at 2am and got him in quickly to talk and this helped him significantly. And he now feels the best he has mentally – it doesn't control him anymoreCasey talks about how few make paramedicine a career, it's a tough job and it has changed over his career, he recommends finding the fun. Learn new things. Self-reflection goes a long wayRecognize when you need to switch to a different place, organization or company as a paramedicCasey: “I feel bad, because I don't feel bad”We all feel different and respond differently to the things we see - you don't choose the things that affect youDon't be afraid to say something to your coworkers if you see something wrong, even though it's hard and confrontational – this helped me significantly when a partner called me out early in my EMT careerWe've lost people in EMS through the years, this is devastating. We share life with our partners and get to know them really wellWhen Eddie was feeling similar thoughts of suicide to our coworkers that committed suicide, it was a huge eye opener for him to see the grief of their lossBad calls can haunt you; we have all seen it in others and ourselvesSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

I tell those EMT's that want to go to PA school or further education to just skip paramedic school. Go to paramedic school if you want to be a paramedic“I'm not doing it for the pay, I'm doing it because I love it.”Being a paramedic puts you in a unique position to save someone's life in the span of 5 minutesEddie took calls personally. He gave every call his everythingSometimes the patients survive despite all the odds being against them and some die despite all the odds being in their favorWe have to remember to respect the patients that may not have earned it because it speaks more about who we are than who they areWe will always have patients that treat us poorly, but it is more about rising above and detachingWe have the privilege of taking care of people on their worst daysEddie talks about how EMS caused him to mature quickly You will always have to deal with Karens in emergency medicine, you must rise above their bad behaviorPatients deserve our professionalism and respect even when they may not have earned itEddie talks about the difference between being in the field as a paramedic and in the EDEddie talks about how important it is to treat your patient as a human and not be a robot but be a human yourselfWe need to build rapport and trust with our patient in order for them to accept our plan of careOften the concern is different than the chief complaintWe talk about how certain tasks become second nature and allow you to converse with patients simultaneously Humor can really help improve your patients' care if you can read the room accuratelyYou don't have to be an extrovert to be successful in EMSWe talk about how, working in emergency medicine, it can really take all the social energy you haveSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

We talk about the immense responsibility and stress of being a paramedic and the stress difference I've noticed moving to ER PACasey talks about RSI and how it still causes his palms to sweatWe should have a healthy respect for high level skillsAs paramedics we can tend to focus too much on a complicated task and neglect the overall picture of what is happening with the patient, a good partner can really help avoid thisIt can be really challenging with a partner that is not watching your back adequately and needs to be micromanaged A good EMT anticipates the paramedics' needsGood BLS will lead to good ALS careYou have to trust yourself as a paramedic before you can trust your partnerThe further you progress in medicine; you tend to stop advertising that you are in medicineSometimes the mistakes or the hard calls are easier to recall than the good calls or the victoriesCasey talks about a rough pediatric call when he was a new paramedicFortunately, the really hard calls are few and far betweenEddie feels like the bad calls are how EMS has damaged him. He struggles to remember the good calls, or the calls where he felt like he did a perfect jobHe lives with regret where he feels like he could have done better as well as the tragic calls and feels like this gets worse with timeSometimes ignoring the trauma for years on end really ends up affecting you when you are olderThe jokes can be a cover for how you really feelBut as a paramedic you have to detach and be above the fray, getting stuck in the same emotions as everyone else will not allow you to effectively do your jobEddie talks about an incredibly tragic case he ran that always haunts himOnce you start getting into the mentality of BSI scene safe, you tend to start practicing that in all areas of life. You get used to always making sure you are safeWe talk about private ambulance and the difference between retirement and disability benefits from fire service It's really hard to switch from being a paramedic to another career after a certain period of timeSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Best online EKG course you can finish in less than 4 hours:Practical EKG Interpretation - Practical EMS4 Category 1 CME credits - Fundamentals through advanced interpretationWelcome our new panel Eddie and Casey, two very experienced paramedics27 and 48 years in the fieldCasey talks about AI potential in the field and a study he was involved in. Will AI help us or improve patient care? Will humans be needed at all?Can AI replicate your gestalt? Is our gestalt worth trusting normally anyway?Why do we see so many paramedics using the career as a steppingstone to other careers, I certainly viewed it this way when I was a paramedicEddie talks about starting in EMS because he knew it was the right thing to do. It feels like that is getting lost due to the softening of medicine. Becoming a paramedic was harder, the barrier to entry was harder. Have we lost our pride in this being a career rather than a job?I remember having a lot of accountability from my peers when I was a new paramedic. I had some level of fear that I would be criticized by other crews and physicians if I didn't perform wellIs part of the difference a lack of feedback from peers and physicians?Has EMS gotten too soft?Casey wonders if we are not putting enough emphasis on accountability to our peers because of fear of offending peopleWe talk about how much fear there used to be of the medical directors. But the environment has changed positively in a lot of ways as we learn and grow from mistakes more than getting punished for themWe talk about being a new EMT, being cockyWhere are the people that want to stay as a paramedic as a career? Not everyone is cut out to make it a long-term careerSome people get stuck in EMS, Eddie and Casey were more intentional about choosing it as their lifeFor some people it's a job, for some it's a lifeHow we present ourselves to the patient is important, we have limited time to make an impression and gain their trustEMS has had periods where different services have just needed “butts in seats” and maybe this led to decreased expectations   Support the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Whatever your beliefs regarding God or lack of a God as you work in emergency medicine, I hope this episode will uplift and encourage youLaurie likes to reflect on the one patient she was there to help during the day. Or the one patient she was there to interact withIt is important to reflect on your highs, your lows and even things that made you laughWhere is that line of caring for people and balancing your own family and priorities?Jesus said the poor you will have with you always. You will never be able to fix every problem. We can't take on a God complex. We have to check on ourselves to know when we are giving too much of ourselvesDaniel raises a point in his book, that the fruits of the Spirit are produced by you going through difficult situations with difficult peopleOvercoming difficult things can make us better if we allow it to and we can be a light to those around usEvery day is not “I am blessed and highly favored”, there are some days where you feel bright and full and others where everything is difficultJesus knows that the pain of getting well is sometimes greater than the pain of staying stuckIs emergency medicine your purpose?Eric talks about the blessing it is to directly impact another person, but it is not his life's mission. His identity is not an ER physician, it is a child of GodLaurie overall agrees but she stresses that she is called to be an ER PA. It's the expression of the skills God has given herI think I am somewhere in between the two of them, I definitely feel called to work in the ED but don't want it to be my whole identity eitherSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Whatever your beliefs regarding God or lack of a God as you work in emergency medicine, I hope this episode will uplift and encourage youDaniel talks about how the most anxious person in the room gets the most attention, but we should strive to be the non-anxious presence in the room. The non-anxious presence rebukes and resets the systemDaniel talks about how the people of God should strive to be like Jesus on the boat when he slept during the storm and say “Peace, be still” to the chaosRemember how we treat people reflects who we areEmotional whiplash occurs as a pastor or as an emergency medical professionalDaniel has gone from dedicating a newborn baby to helping a patient pass peacefullyHabits to hit the reset button: I like to walk to patient rooms rather than speed walking. This allows me to take a deep breath, practice mindfulness and reset myself to approach the encounter wellSlow is smooth, smooth is fastTry to smile Engage with the patients that fill your cup and appreciate your care, talk with that staff member that is kind and happyDaniel talks about breath prayers: “Come Lord Jesus”, “help me Lord,” “Lord I need you here” “Come Holy Spirit”Daniel talks about how we help with anxiety. When he sees people in his office at church or in the hospital, they are often anxious just like our patientsHe says one way he combats anxiety is asking the person's full name. What does your middle name mean? Is that a family name? He quickly digs into the details about a person's life, and this can cause the anxiety to diminish. It shows interest in the personThe greatest sound to a person is the sound of their own nameOften the patients chief concern is not the same as their chief complaint In order to give to others, you have to have a full cup first, then what overflows is what you have available for othersHow do we unburden ourselves of the things we take on at work?Eric can compartmentalizeLaurie talks with her spouse to digest the things that happen during the dayPersonally, sometimes I want to talk about my day and other times I don't want to talk at all about my dayDaniel talks about how to avoid “taking home the hitchhikers.” We often see sad stories in our line of work and we can't allow this to negatively impact our close relationshipsDaniel jumps on his trampoline, screams into a pillow or goes to a steam room and gives the burdens over to the Lord. He also doesn't shield his life from his family. He shares the difficult thingsSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Whatever your beliefs regarding God or lack of a God as you work in emergency medicine, I hope this episode will uplift and encourage youNew panel! Welcome Pastor Daniel Grothe, ER Physician Eric and ER PA LaurieDaniel talks about the life of a pastor, which isn't exactly as we all might assume. He talks about being a brand new, young pastor and how he responded to the home after the suicide of a 16-year-old boyOne of his first calls as the pastor on-call was the death of a 7-month-old boyHis experience, being a young pastor, not fully trained in how to handle the most difficult of scenarios, but jumping in anyway is not dissimilar to being a new EMT or paramedicHe's not worrying about the medicine aspects like we do but his frequency of dealing with death and dying is very similar to my experienceHe talks about how we come into peoples lives where they are and try to bring healing to them, and this can be costly for us as wellThe ratios of doing the big things like weddings and sermons to the dealing with death and dying is not what you might expect as a pastor, a large portion of time is spent walking through the valley of the shadow of death with othersLaurie talks about an ER she used to work at and the amount of trauma they saw that was often not survivableI recount the cardiac arrest of a 4-year-old I ran years ago and how this caused me to wrestle with GodDaniel talks about the times he has wrestled with God. Including the time New Life Church had an active shooter on campus that killed two young girlsChristians often want to see things like the stories in the book of Acts, miracles. But Acts takes place in 5 cities over 40 years. So, Daniel says, stick around a place for 40 years and you will see all of those things happen while also attending funerals and seeing deathWhy do bad things happen to good people?Daniel looks at what we do as working on this side of eternity to participate with God to be God's representative to those that are sufferingWe all get into the field to help others, but this can get lost in the tasks we have to do during the dayWe have to remember that our actions and how we treat patients, regardless of complaint can demonstrate God's loveBurnout comradery is a problem when we all get in a feedback cycle of complaining about the day and the patients.  It might feel good in the moment, but it leads to burnout“That smelly homeless person that just puked on my shoes is made in the image of God”We can choose to be the peace and calm in every scenarioSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Kevin Hazzard Author of A Thousand Naked Strangers and American Sirens (you can find these on Amazon or wherever books are sold). You can find Kevin Hazzard at KevinHazzard.comKevin talks about the story Jesus told of the good Samaritan as really the first example of EMS. Jesus tells this story in response to a lawyer asking him how to obtain eternal life. A man was attacked on the road and left for dead. Many people that society perceives as “good” pass by this man but a Samaritan took the time to stop, dress his wounds and takes him somewhere to put a roof over his head and allow him to healKevin talks about how society has never put sustained efforts into saving people outside of the hospital until the 60'sThe white paper published in the 60's indicated that you were more likely to survive a gunshot wound in the Vietnam war than in the streets of the United States because you would have someone trained in first aid at your sideThere was significant emphasis on intubation for early paramedics. This was a skill very important to the early physicians because they knew the life saving potential We talk about the evolution of intubation and how emphasis seems to be changing and the important of still training on this skill because it can be very difficult and high stressI think it is important to increase training rather than remove a skill set from paramedicsWe talk about video options for intubation and the potential future of trainingThe first paramedics in American Sirens were black men that served their community called “The Hill”Pittsburgh in the 1960's was a very difficult city for African Americans. Jobs were not available. They were told they had no value. Then Freedom House ambulance gave them a purpose designed by the father of CPR himself, Peter SafarGoing from not worthy of anything to being trusted with paramedicine at the highest level for your own neighbors, your own communityThe first call they run is in the aftermath of Dr. Martin Luther King Jr's assassinationPeter Safar, the father of CPR and an anesthesiologist, designed the early ambulances in a configuration that is still used today, a captains chair because he wanted good access to the airwayTheir first medical director, Nancy Caroline, wrote the foundational EMT education text bookThe great tragedy is no one can really tell you about Freedom House ambulance until now, the story was intentionally buried and forgotten“This need to be corrected,” Kevin Hazzard tells the important storySupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Kevin Hazzard Author of A Thousand Naked Strangers and American Sirens (you can find these on Amazon or wherever books are sold). You can find Kevin Hazzard at KevinHazzard.comWhat does Kevin miss about EMS?He misses the partnerships and the chaos you went through together.The memories he has are both good and bad from his time in EMS, the failures and the mistakes but also the victoriesWe get into Kevin's newest book American SirensWe talk about the difficulties in controlling and bringing order to a chaotic scene and how this is a skill that has to be developed over timeKevin tells a story about a call with a panic attack and how this may be normal for us but for the patient experiencing the symptoms, it may be a real unique and scary scenarioKevin's “large” partner would take control of the scene that was out of control by pushing the biggest dude up against a wall and then everyone else would back downEven without size on your side you have to present external confidence on scenesA situation that, by definition, is out of control, must be controlledEven those scenes that are not out of control, you still need to convince grandpa that you will take great care of grandma and you understand how important she isWe talk about the story of John in American Sirens and how EMS gave him purpose and how EMS gave us purpose as wellJohn was a black man that grew up in a segregated city, extreme poverty, his mother died of alcoholism and his father ultimately had to give him up to an orphanage. But John didn't give up and he saw the respect and dignity that was given the earliest paramedics at Freedom House ambulance, even as black men, and worked his way into practicing paramedicine at the highest levelThis was a time that, in the city of Pittsburgh, if you had a medical emergency, it was handled by two copsKevin does a great job of articulating Johns full circle in the book. He goes from orderly, the lowest of the lows in the hospital, to practicing paramedicine at the highest level, intubation, and bringing in critical patients into the same hospital EDSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Kevin Hazzard Author of A Thousand Naked Strangers and American Sirens (you can find these on Amazon or wherever books are sold). You can find Kevin Hazzard at KevinHazzard.comWe talk about the difference of caring for someone dying in their home vs the hospital bedThere is something more intimate about dealing with death in a home, where the person had livedIn a lot of way this is harder to deal with in a patient's home than my role in the ER as a PA, where I have more resources to manage the family dynamicsKevin talks about how the crew emphasized the fighting component of the job when he did his early EMT ride-a-longs. We talk about fighting patients and how a lot of times this can be avoided. It comes down to your relationship with the patient and how you present yourself. Many fights are unavoidable, but some are inevitable Kevin talks about being more tourist than devoted to learning early in his career. About how a partner helped make him a true believerOur partners make such a huge difference, they can show us how the job is or is not supposed to be done“You should wake up every day excited to be here and learn the medicine” There's no mystical force we tap into, it's about learning the medicine. It's you and another human being with a few tools at your disposal Appreciate the incredible opportunity you have to be thereKevin talks about his stent as a paragod and how this came to an end“Hubris comes before the fall”Kevin talks about an embarrassing moment that ended his paragod phase when he brought in a cardiac arrest with lividity Humbling experiences will occur and end that paragod phase, hopefully you learn from your mistakesWe talk about moving on from EMS and how the options are really limited for a paramedic looking to progress. There is no natural movement upwardKevin talks about the struggle of identifying with a profession like paramedicine or being a firefighter and how this can make it difficult to move on, even when you shouldIt was hard for him to move on when being a paramedic was such a big part of who he was and was the motivating factor behind writing A Thousand Naked StrangersSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Kevin Hazzard Author of A Thousand Naked Strangers and American Sirens (you can find these on Amazon or wherever books are sold). You can find Kevin Hazzard at KevinHazzard.comParamedic from 2004-2013 for Grady hospital in AtlantaHe talks about the self-doubt he had in the writing process and how he wasn't sure anyone would relate to his storiesHowever, the specific details he describes are super relatable for those of us with experience in EMSKevin talks about the writing process, getting book deals and his work on Hollywood films/moviesHe talks about how he got a lot of “no's” before he found a literary agent and a publisherHis motivation for writing was to tell the journey of who he was at the beginning of his career in EMS and who he had becameExpect that you will get a lot of no's and a lot of failure until you get the right agent. Find an agent that sees your vision that you can build a relationship withA Thousand Naked Strangers was published in 2016Kevin wrote one of the best accounts of the EMT school experience I have ever readImposter syndrome seems to be a newer term but is a feeling we all have, especially in EMT school this is a common experience Support the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Don't make your career your entire personality, extra shifts will affect you over time. Sometimes the extra money is not worth the burnoutThe culture is shifting from working a ton to a better work life balanceYour family will remember that extra shift you worked far longer than your employerGet off on timeControl the variables you can control that give you higher chance of getting off on timeLeave work at workBurnout can be short term or long term, acute or chronicIf you cannot take care of yourself, you cannot take care of others wellStrive to live a healthy lifestyle Don't let your relationships falter because you are too busyDon't take those patients that are terrible to you personally. We are seeing patients on the worst day of their livesThe environment we work in is one of the most challenging out thereLearn what burnout looks like for you individuallySchedule time to relax and spend time with friends Have a system for overcoming burnout, maybe therapy, maybe exerciseYou have to manage and recognize compassion fatigue to avoid taking out your stress on other people that don't deserve itDon't wear things as a badge of honor that are not good things: like not drinking water all shiftAvoid the bad habits that allow a short-term benefit for a long-term detriment Selflessness is a big part of who we are, but this can be a point of damage if you don't take care of yourselfUnderstand that we are all working as a team. You have to understand your role and work efficiently within that role Lucas talks about a very personal experience with EMS, law enforcement and the ER. He realized that anyone of these people could have been the last to see his son alive. And we are that for other people many times. We are a tribe. Support the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Batching work applies with nurses too. Do multiples things when you enter the room, so you don't have to go in and out many timesBen talks about efficiency in the field being important due to the limited time and resourcesAs providers we must get comfortable with saying “I don't know”In medicine in general we don't know everything, nor can we diagnose everything. Especially true in emergency medicineChest pain is a great example. We don't get a clear answer or diagnose most of the timeWe must be careful what we tell patients is going on when there is not a clear answer. Specific diagnoses will follow patient for a long time Ben talks about some struggles new EMT and paramedics have and how the scope of a paramedic is still poorly understood, they often hear “I didn't know you could do that?”Teaching the EMT and paramedic students the context of the “why” behind treatments and not just the skills themselvesThe difference between magic and medicine is we can trouble shoot and analyze medicine, we know why it works and if it doesn't there is usually an explanationKeep your mind open and learn from others. You can usually find someone that has a similar style as you, but you can also learn a ton from those who practice different from youAsk a lot of questions, grow your confidence graduallyYou need to master the more mundane tasks before moving to the exciting in some circumstancesCharge nurses need to help develop their team and communicate wellBe a mentor and correct people in a non-public setting, grow people instead of getting rid of them if they are strugglingFind a mentor or multiple mentors when you are new and when you have some experience, mentor people You must be constantly teaching newer people and learning from more experienced people in medicineYou can make or break someone's medical experience when they are new to the fieldCultures can be developed by the poor attitudes of a few crews or staffYou have to guard against the bias that those that are burned out can bringConstructive criticism can come from even those that are not nice or not tactful if you can be open enough to take the feedbackYou can learn from anyone, even those lower on the perceived hierarchySupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

New panel! Lucas (ER physician), Kendra (Charge RN, NP student), Ben (paramedic and educator)Kendra talks about her advice for new charge RN'sHave some ER experience first. She says it was difficult starting as a charge when she was so new to ER. Have a good set foundation. You need to be able to have difficult conversations with people in a tactful way to address problemsGetting to know the providers on a more personal level also allows you to better counteract interpersonal conflicts Lucas talks about how a good charge nurse is a problem solver. He doesn't view himself as the captain of the ship as an ER physician. He views the charge nurse as the problem solver and it's their job to make sure every patient is managed in the departmentThe progression from EMT to paramedic is a similar advancement as RN to charge RN. Thinking outside the box instead of just task-oriented workParamedics must learn to allocate resources appropriately rather than do the tasks themselvesSimulation based training has help new paramedics learn to lead calls and see the time it takes for tasks to get completedParamedics do tend to have chips on their shoulders, a lot of this has to do with the difficulty of the job and how it is fairly new by comparison and the history of EMS is often us trying to prove ourselvesLucas discusses efficiency tips in the EDChart with the same basic structure regardless of the chief complaint The physical exam can be very basic and general with a very detailed focused physical exam based on the complaintSometimes documenting a physical exam that is too thorough can bite you later when you have to answer why you did a cranial nerve exam on an abdominal pain patientDocument what was done and do what you documentMore is not always betterDocument twice as much as you think you need to on the relevant componentsWhen you are new as a physician or APP you should be ordering more and documenting moreTry to batch tasks. When you get up go see multiple patients rather than one at a timeIt's better to do the right tests rather than use a shot gun approach every timeYou should be able to answer what you are looking for with a given testOn most patients, you should be able to form a plan after getting the HPI and physical examWe should seek to avoid stacking orders, sometimes it's inevitable when unexpected results pop up Stacking orders reallSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Lorihodges.com  (4) Lori Hodges, MA, CCP, PMP | LinkedInShaking In The Forest: Finding Light in the Darkness: Hodges, Lori R.: 9798888244005: Amazon.com: BooksDebriefing helps to learn from a big crisis and then move on without continuing to judge yourself and your mistakesWe all make mistakes, getting stuck in the mindset of constantly reviewing what you could have done differently and dwelling on it is not helpful long term and can impact your next patient if you are distractedIt's okay to not be okay and seek help for the things you are struggling with. We need to talk more about this in EMSWe see things that humans are not meant to see. We must be intentional about healing from the traumaWe all develop positive and negative coping mechanisms. We need to be aware of theseDark humor is one of these strategies we commonly useLori talks about the hypervigilance she developed growing up with her father as an alcoholic. She picks up on subtle cues that others might miss as a resultIt is important to take concerns from other emergency providers seriously, especially if they are spending more time with the patient. It's important to build that trust with those around youFinding the balance between compassion and carrying another's burden is difficult It's also important to be able to teach others in emergencies by allowing them to make the decisions themselves but also being there to catch themLori talks about how she trains new emergency managers by allowing them to do hard things while being there to support themLori talks about how sometimes allowing people to learn from their mistakes instead of just firing them makes for better managers Allowing people to admit their mistakes makes for a better environment where everyone is improving instead of being afraid to admit their errorsCollateral beauty is the light in the darkness, that must be Support the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Lorihodges.com  (4) Lori Hodges, MA, CCP, PMP | LinkedInShaking In The Forest: Finding Light in the Darkness: Hodges, Lori R.: 9798888244005: Amazon.com: BooksLori Hodges, is the author of Shaking in the Forest, Finding Light in the Darkness. She is a former paramedic and firefighter in Colorado and currently works as an emergency manager, recently working on hurricane Milton in Florida.She talks about trusting your paramedic intuition on scenes and gives a vivid example of how trusting herself on a scene, despite others adamant that there were no other victims on scene, found another ejection victim of a motor vehicle accidentWe talk about some of the unexplainable experiences we have as paramedics and how many of us have these similar storiesLori talks about a feeling she would get the morning of a shift where she would know that a patient would die before it would actually happen and how the feeling would resolve after running the callI always try to take the patient more seriously when the EMS crews have been concerned enough to put on the defibrillation padsAn important rule in EMS is no running and no yelling. We must be the calm. Lori talks about how this is even more important as an emergency manager. As leaders, we are watched and people take their cues from us. They will tend to mirror our behaviorWe have to detach to make sure we take everything in and not get stuck doing one specific taskIt is hard to be the one that stands back and doesn't do the skills as a new paramedic, but it helps you take in the whole pictureLori dealt with addiction and it's affects while working at a detox center. She also dealt with it personally in her relationship with her father. She had to learn to set up boundaries with him Our partners and fellow EMS coworkers are fighting their own battles, remember to have grace for people. Sometimes how they come across is not how they intendEMS challenges Support the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Kelly Grayson is a very experienced paramedic, educator, speaker and author that serves the EMS community. You can follow him here: (10) Kelly Grayson (@AmboDriver) / X (20+) FacebookYou can find his books on AmazonAmazon.com: On Scene: More Stories of Life, Death and Everything In Between (A Paramedic's Stories of Life, Death and Everything In Between Book 2) eBook : Grayson, Steven "Kelly" : Kindle StoreEn Route: A Paramedic's Stories of Life, Death and Everything In Between: Grayson, Steven Kelly: 9781537770819: Amazon.com: BooksHow to compartmentalize and do our job without losing our humanity. This is a balance we are all trying to findKelly talks about how he had to detach in order to quickly triage on a scene and how this is necessary to do the job a lot of timesJoy and pain are different sides of the same coin; if you insulate from one you deny the enjoyment of the otherIf you don't let the failure to resuscitate a pediatric patient bother you, how can you feel the joy of delivering a baby?Often we are spending more time with the lowest of society rather than on our own health and well-being You have to be able to step away from EMS and leave work at work. But we all know this is very difficult. You need to share your feelings with your family. Holding it all inside is not helpfulKelly talks about how this lack of communication cost him aSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

Kelly Grayson is a very experienced paramedic, educator, speaker and author that serves the EMS community. You can follow him here: (10) Kelly Grayson (@AmboDriver) / X (20+) FacebookYou can find his books on AmazonAmazon.com: On Scene: More Stories of Life, Death and Everything In Between (A Paramedic's Stories of Life, Death and Everything In Between Book 2) eBook : Grayson, Steven "Kelly" : Kindle StoreEn Route: A Paramedic's Stories of Life, Death and Everything In Between: Grayson, Steven Kelly: 9781537770819: Amazon.com: BooksKelly talks about how he was cocky for many years when he first started as a paramedic. Paramedics often go one of two routes: God's gift to paramedicine or bringing their text books around in fear every dayKelly re published En route and On Scene the way he meant to release them in the first place in 2023A lot of us go through the “God's gift to paramedicine” phase of our career when we are overly-confident when we are newKelly tells a moving story about an elderly woman and how not everyone wants to be savedSupport the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Nick talks about a difficult RSI intubation and his struggle to overcome the feeling that he didn't do his bestWe talk about how intubation success was such a critical point as a paramedic that everyone would have judged you on in the pastWe talk about the direct laryngoscopy vs the new video techniquesAdvice for the newbies:  Brent: You're going to struggle with burnout. You need to recognize it early. Prepare for that possibility. Nick: The things that affect you are different for everyone. Certain things you think may not affect you will actually become a problem for you later. You can't choose the things that you will struggle with. Always treat the patient well and don't blame them for the problem they are having. It is not all about you. Treat people with respect and give them options. Let them save face.Mark: Recognize that your happiness is up to you. Don't expect the company or organization to give you your happiness or your wellbeing. If you see yourself getting less happy, you don't owe the organization anything. You make the decisions that affect your life. We can't blame the environment we choose. Make a change if you need to.The mountain will always be the mountain. We have better gear than we did before but that doesn't make the challenge itself that much easier. EMS is tough field and that will always be the caseKnowing when to step away is also importantNick's metaphor: Event horizons are the edge of a black hole. If you were in space and you passed into an event horizon you probably wouldn't even notice.  But from the outside, you would just appear to disappear. Event horizons appear in our careers as well. You may not really understand you are at that point of terminal burnout but looking back you might be able to pinpoint that point of no return that you crossed.Where is the event horizon on a call? That point of no return where the outcome is assured.Support the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Nick talks about a difficult traffic accident and how something that seems like not a big deal but actually affected him – we can't choose the things that affect usIs there something protective in the fire or law enforcement world that helps with longevity? Is it the wider variety of calls? EMDR (eye movement desensitization and reprocessing) is a form of psychotherapy that Nick had some great results from utilizing and highly recommends to those strugglingWorking together as a tribe is a key aspect of a functional scene. Everyone has their roles, their strengths and they complement each otherWhen things would go bad, Nick would take all the responsibility on himself but share the successes with everyoneNick talks about an officer that was vulnerable enough to go into the details about a difficult call where he ended up struggling for his life and how this inspired him to get some help and talk about past trauma as wellIt is important to recognize your need for help before it becomes a big problemOur experience on the panel leads us to believe that we are more likely to respond in anger as men in EMS – maybe that prevents us from seeking help soonerSupport the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Why did Nick switch to law enforcement? He burned out on medicineWhat does he miss the most: The team mentality. The fire crews that he grew close to. He felt certain they could handle whatever call came their wayWe talk about the struggles working a 48-hour shift with a rural fire department but also having to manage the expectation from the private ambulance company that you run calls in a much wider radius to include the city when neededSleep deprivation is a big factor in burnoutNick talks about his heavy caffeine intake and how he started having runs of dysrhythmia that later required a cardiac ablation for atrial flutterWhat does Nick not miss? Getting up to run calls. The tiredness. The anger and helplessnessI remember getting to my absolute wits end on those 48-hour shifts and having to call our supervisor and tell them we were done running calls because we were so tiredNick talks about how he could feel that stress and sleep deprivation damaging him in real time, like if his hand was on fireThe stress level of running those calls an hour from the hospital with no other paramedic on scene and having to perform high level skills has not been matched as a PA in the EDNick talks about how, even in law enforcement, his fear of the next call is not equal to what it was as a paramedicBrent talks about a time when Nick was so angry he started stabbing his seat beltDon't blame the patient for their medical emergencies and don't take your frustrations out on themNick talks about losing his temper on an innocent dispatcher after a hard nightWhy do we see more resiliency and less burnout on the fire side?Maybe the team mentality on the fire department, ability to move to slower shifts, debriefingWe all tend to get support after that horrific call that makes the news, but a bigger problem might be the micro-traumas that we all undergo day in and day outResiliency needs to be built into the system – you are going to get burned out and have a tough day at some point and it needs to be prepared forWe don't typically lie to ourselves that we are “okay,” we may genuinely feel okay. It's later that situations and calls may Support the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Mark (paramedic) | Brent (fire officer and EMT) | Nick (former paramedic and current police officer)Mark has worked in urban and very rural 911 ambulances and does part time EMT education now  Community paramedicine is an emerging field and can vary a lot from region to region. Paramedics are flexible providers, so the potential is hugeBrent has stuck with firefighting from his early days as a recruit all the way to becoming a fire officerNick has transitioned from EMS to law enforcement in the last several yearsThe history of the spine board is a good lesson for new people: The way we practice medicine is a constantly moving target. Best practice is not always based on good data. We used to put EVERYONE on a spine board, but this has turned out to likely be doing more harm than goodEven though logically something might make sense, it doesn't mean it always does in reality. Backboards and epi are big examples of thisMark talks about the history of backboards and how this practice came to beAn important point to remember in emergency medicine: If you have nothing really wrong with you, we are more likely to harm you than help you with treatment. This is because nothing comes without risk and if there is truly nothing to treat, the scale weighs entirely to the risk side.Support the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Nate talks about a motorcycle crash he stopped at on his way home and how he was critical in saving an injured patient and how he became close with the family who still talk to him today. Even though the patient ultimately died, the impact he made on that family was immense. Patients remember usWe need to remember we treat a person not a complaint or a room numberThe balance is finding the human connection while not over-empathizing and taking on burdens that are not yours to bareWe talk about moral injury vs burnout – I do agree that we do not need to blame the individual for their burnout. It is certainly caused from many factors outside of their control factor BUT I like to place the responsibility for overcoming burnout on the individual because no one is coming to save us. Looking to blame external factors doesn't help us in the long runMental health struggles are not always obvious to us in people we spend time withCasey talks about how the cooperate leaders are actually trying to do the right thing for the front-line workers in spite of what we might think about themWhat advice for yourself 5-10 years ago?Nate: Slow down. Listen to those with experience. Bring your love of the job to someone else, especially new people. Kash: Remember that you don't have to do everything on your own. EM is a team sport.Aaron: Enjoy teaching the newbies. You can make or break their experience based on your affect. Casey: Journal your days in EMS. The babies you deliver. The skills you perform. Something to look back on can be very valuable.We mean a lot to new people and students so remember the influence you have on peopleSupport the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

The paradigm around rapid sequence intubation is evolving and becoming much safer with more education and procedures. Sometimes in emergency medicine slow is better. We need to stay mindful and calm in chaos and this requires us to detach and be above the fray and walk slowly instead of run. This will actually increase effectiveness and efficiency. Nate recounts his EMT rides with myself and a great paramedic partner I had named JustinNate actually paid in EMT school to do more third rides so he could learn from the crews that were good at teachingCrews can make or break an EMT students experience Nate talks about how you really have to love EMS. The things we see are difficult, the shifts are long, the pay is not great. Something has to get you throughWhat affects one person may not affect another. Casey talks about how it can be tough when things don't affect you at all. That can be a form of struggle as well. We talk about some of the hardest things to see in EMS, the cries of a mother or father at the loss of a child. I talk about, how as an ER PA, I am a little more insulated from the death and the conversations with family than I was as a paramedic. Nate talks about looking for the good differences you make with people. His job is not to save a life but to prolong lives.Be intentional about marking those good momentsCasey talks about how a patients family remembered him long after a callSupport the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

EMS varies significantly from state to state so you get a wide range in the abilities of EMT's and paramedics nation wideCase reviews are moving to an educational rather than a punitive model There is no true national standard for EMT's and paramedic's which further complicates thingsThe regions that EMS is practiced in vary a ton as well. Skills may need to be performed much more frequently in an urban area vs a very rural areaSenior, experienced providers should use opportunities to show the newbies how to do skills rather than perform them themselvesOne of the hardest parts of being a paramedic is standing back and delegating instead of doing the actual skillsEMS still falls under the department of transportation which is the department it was founded underStandardization nationwide for EMS practice is difficult for multiple reasons, a big one is EMS needs and patients can vary a lot from region to region. Call volumes are very different from region to region. Support the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Meet our new panelKash (EM physician)Casey (Paramedic)Nate (EMT)Why emergency medicine?Kash: Likes to see results in the short term rather than manage long-term problems. Decided on EM and even an EMS fellowship before starting med school after getting his EMTAaron: When in PA school you really need to be at least considering primary care but I decided it was not for me. A day in primary care tended to really drag for me while emergency medicine makes the day go by quicklyNate: Initially wanted to be a firefighter but enjoyed the medical side more and eventually got his EMT. He loves the diversity of the patients and the chance to help people. He loves critical care transport with the increased knowledge he has gainedNate: Learn to slow down. Kash: Don't just do something, stand there.Fix the underlying issue. Don't just blindly treat numbers. Fix the why, don't just react.Casey talks about a scenario where slowing down was critical to catching important details during an RSI. Sometimes the whole team gets so focused on individual tasks that simple things (like low O2 sats) can get missed.Checklists can be critical to making sure the simple doesn't get missedWe all need to have humility I address the video that got taken out of context after people thought we were directly comparing EMT's to CNA's. That was definitely not the intent. Nate talks about how he is proud and protective about what we do in EMSSupport the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Matt talks about our reliance on technology and how sometimes it is nice to remember that to assess a patient it is actually really simple without using technologyAndrew: I am mostly paid to not get tricked into missing something big.Standards in medical education changing when there is emphasis on getting people through programsKeep holding high standards for your studentsAdvice for the newbies:Andrew: You won't fail if you are trying your best and making the best decisions you can and caring for the patientAaron: Take care of yourself before you take care of patientsMatt: Ask for help if you need it. Julie: Be content with where you are atSarah: Progress further in medicine if you can do itSchasny: Don't listen to the naysayers. Zero to hero is possible because everyone is differentYou can learn from all providers, even if they haven't been in the field long.  Sometimes experience can be greatly varied even with only a short amount of time in the careerSupport the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Imminent baby delivery stories Burnout tips: avoid the overtime. Sometimes the extra money is not worth the additional life stress.Make sure you get off on time and make that transition to home life.Andrew uses audio books so he has something to look forward to while driving to and from shift.Patients are often not even the source of our stress, it's operational difficulties, interpersonal difficulties and decision fatigue. Decision fatigue is a big issue we face in our home lives after a significant portion of our day being in fight and flight modeWe talk about driving lights and sirens to every call and the dangers associated with this to the crew and publicThis likely doesn't save lives in any meaningful way that justifies the dangerThere is a big push to decrease the emergent responsesWe talk about the hazards with emergent returns, the confusion other drivers may have, the danger for the patient and crews.Road rage isn't worth engaging in, remember that the bar to obtain a drivers license is very low and many of the meth-using patients we take care of will drive as well. You never know what kind of person is in that other car. I bring back up the discussion of “Where is God is emergency medicine?”We see the whole spectrum of life and death. We see people come back from the brink of death that logically shouldn't and those that succumb that logically shouldn't. We talk about strategies to compartmentalize and move on to the next patientSchasny talks about the traumatic life and medical experiences she has come through and how they have changed her view on religion Support the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

The team mentality at all levels in the ED is key to a harmonious, efficient and effective environmentIn EMS, this can be difficult on a given scene when you may not know the other responders all that well and it can be easy to get offended when no offense was meantDeveloping a thick skin is important in emergency medicine. You can't allow negative emotions of others to affect you all day long.Patients can be really mean. This is just a fact that can be expected so you can make a plan to deal with it.One of the cool things about being an emergency medicine provider is that we are the provider that the patient has access to any time of day or night. We are not a expert in any one specialty and that is okay.Sarah talks about a rough shift in the fast-track part of the EDAndrew talks about the first code he ran as a medical student and the impact it had on him It is an honor to be there at a patients last moments and to help their families through it. It is very easy to forget the human side of emergency medicine. Ask yourself how you would act if it was your family, you were taking care of.Slow down. Focus on making a connection.I naturally fall out of making that human connection, so I have to be intentional about connection it or I won't happen. Paramedics and EMT's have a tendency to measure success and contentment by the acuity of the calls they run. I would venture to say we need a better metric: human connection. If you can connect with your patients, this will prevent burnout in your own life and improve your patient care as well.Strategies for avoiding burnout: music on shift, nebulizing coffee to neutralize bad smells and planning tripsCrazy stickers for comedic reliefWe talk about the inaccuracy of pain scales and alternate pain scalesSchasny talks about a patient with an ingrown toenail that got up and left after hearing multiple traumas and code blues announced overhead. Support the showIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Meet our new panelMatt (EMT) Julie (RN) Sarah (paramedic) Schasny (paramedic) Andrew (EM physician)Advice for the newbies: Don't panic, it is not your emergencyFind the balance of detachment while still making sure the patient feels cared for and understoodPart of avoiding burnout is taking some time to access the human side of youself in caring for a patient while also not taking the emotional stuff home with youYou don't know it all when you are new. You have just been deemed safe enough to do the job. Knowing where your limits are is important when you are newDon't be afraid to ask more questions of those around you in the beginningBeing a new paramedic has its own challenges as there really is no one to consult or provide direct feedback after a treatmentSome ER physicians are not familiar with EMS protocols so have some grace for this situationIn the ED, we must remember that EMS crews have a ton of operational problems to overcome on calls AS WELL as treating the patient for an emergent condition. Confidence and experience only come by running call after call. You must see a lot of patients. Medicine is an art not an exact scienceMultitasking as an ER provider is just rapidly changing between focuses but is a huge skill you have to developBe in the chaos but staying organized is key to this “multitasking”Another difficulty as a new ER provider is figuring out the order in which to complete the tasks you have to doControlled drowning. New people need to be allowed to feel the pressure and the stress while still having a backup so they don't experience this for the first time by themselves. Find a method to not let tasks get forgotten.I talk about overwhelm when I was a new PASupport the Show.If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Keep asking “why” do get to a full understanding of what is going onAs providers we do want questions asked of us if someone is not sure about something we orderedTracey has found techniques to avoid burnout despite 24 years in emergency medicine, she says it is very individualized how you overcome burnoutBelligerent patients do cause burnout and the job to be very difficult in generalTaking intentional time to connect with your patients will help overcome burnoutTracey has advice to give patients grace Adam: purpose in life is important to avoid burnout. He believes he is called to be here. Exercise, spend time with family, move your body, work less or even work more now to work less laterForce yourself to be social on days off, even if you might not feel like it. This will often help your mental well-being.Owning your mistakes is key to avoiding burnoutUnderstand we will make mistakes and even when everything goes perfect, we cannot save the patient every time We really aren't built to see a lot of the things we have to see in emergency medicineBe patient with the patients we deal with. They are going through something that we are not and have concerns we may not know about. They are scared, they are frustrated.  You need to have a sense of humor and the ability to compartmentalize Compartmentalization helps to move on to other tasks that need to be doneKate tells a story about compartmentalizationIt is okay to set boundaries with patients that push on the limitsDeescalating belligerent patients is a skill that can be learned Support the Show.If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

We talk about EKG interpretation Adam talks about the power of teachingOngoing learning is key to performing well in emergency medicine and medicine in generalWe discuss confidence in emergency medicine and The Dunning-Kruger effect:People with limited competence tend towards an overestimation of their abilities It is very dangerous at the top of this curve before you recognize your limitsMost of us feel this effect when we are new to a new level or fieldBuilding confidence depends on the individualI talk about my own overestimation of my abilities as a new EMT Your partner on the ambulance can really encourage or limit your interaction with the Dunning-Kruger EffectEven Adam, who admittedly doesn't lack confidence, took about 3 years as an attending to gain confidenceFor Kim, it took about a year to really build confidence, but also notably in a busy system. However, she still wanted time before taking students. She did that at about the 3 year mark.As a PA, I think experience teaches you where your limits are.Adam often talks through complicated problems out loud while working in the ED Kim makes a great point about experienced EMT's lacking the background knowledge and the “why” behind treatments. This “why” is critical to learn in medicineAdam tells a story about how the “why” is so important. You cannot blindly treat a number. You must take into account the whole clinical picture.Doing nothing is the right answer sometimes.I tell a story about a paramedic, Amanda, and how doing nothing was the right answer for a patient. Support the Show.If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Stress exposure in school is very helpful for real life practiceA good analogy for lay people: EMT is like CNA, AEMT is LPN, paramedic is RN. This helps people understand the progression of levels of care betterParamedics need to be learning provider type assessments on rotation not nursing assessmentsKim talks about the zero to hero debate: Experience matters not just in emergency medicine. The main difference is the individuals drive and education Kim talks about a hypoglycemic patient when she was a new paramedic Kate talks about the difficulty in bringing up possible concerns with providers and how important it is for the providers and advocating for patientsAdam discusses listening to EMS and the patient and the importance of what the patient looked like before they got to you.Understanding your EMS system is important as an ED providerWe talk about the value of interpreting lab work in the fieldSupport the Show.If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

We meet our new panelistsKate (EMT)Kim (Paramedic and educator)Tracey (Former paramedic and current PA) Adam (Former paramedic and current EM physician) Kate talks about how the public doesn't know the difference between EMT's and paramedicsTracey talks about a humbling experience in her early career where she did not know where her equipment was in the ambulanceKim talks about changes in paramedic and EMT education. Historically you retain 20% of the information in a lecture format. That has been increased to 80% retention with new techniques like switching to simulation and active learning techniquesPutting the responsibility on the students to perfect their skills is something they will have to maintain in the field as wellSwitching to competency-based education from hours based has been a huge changeSimulation based training is very valuable. It teaches you techniques and de-escalation techniques that you can't learn from text booksWe talk about medical scenarios outside of work and how our skills come into playSupport the Show.If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Be willing to speak up. Sometimes you might be the only person to notice something important. We need resiliency in this field. We are all still learning, so stand up and advocate for your patient.Regardless of your level of care, you need to advocate for your patient. The hierarchy is largely in your mind. Don't be afraid to approach someone with a perceived higher status than your own.Take ownership over patient careConfidence varies in how long it takes to developBe willing to be uncomfortable, it is how you will continue to learnBe willing to make mistakesEMS to in-hospital care can be a steep learning curve even as an EMTWe talk IV's and IO's, staples, “foley buddies and “no no zones” discussionSupport the Show.If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

Nate (EMT) shares his story and the issues he has been dealing with.Nate overdosed on medication and ended up in inpatient psych care which helped him immensely. He still feels grief from time to time but does have happiness more now. Nate wants people to know that these struggles are real and you are not alone. Don't be afraid to talk about it. Seek counseling and therapy. The field we work in makes us prone to dealing with mental stress and health.Dark humor is a method we use to move on to the next patient or next call.Our job is to help the body heal itself, sometimes this doesn't work and we can't get caught up in the times when it doesn't work. We must be comfortable outside of that control. We can't save everyone.A bad partner or burned out partner on the ambulance can really ruin your experience. We all need to be willing to teach in a tactful nonjudgmental way.Sometimes doing nothing is the right answer if a patient needs an OR and a rapid transport is necessary If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks:https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMSMy favorite creatine supplementhttps://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.1st Phorm | The Foundation of High Performance NutritionEverything you hear today from myself and my guests is opinion only and doeSupport the Show.If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks: https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS My favorite creatine supplement https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...

We meet our new panel:Eric (EM Physician)Shelby (EMT)Nate (EMT) and returning guestSam (Prior EMT, ER RN)DeTessa (ER RN) Part of the fun part of the ER is getting to start from scratch and figure out the puzzleStories do change as the patient talks with different providersWe are not equipped to diagnosis or resolve chronic problems in the ED, we can't provide every answer for every symptomThe mindset of the public of what the ER is vs reality is often quite differentWe do need to understand that waiting for your ER work up can be very difficult as a patient, especially when you are in pain.We need to have grace for this patient perspective We talk about GSW patients and chaos that is present on scene and in the hospitalIf you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks:https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMSMy favorite creatine supplementhttps://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.1st Phorm | The Foundation of High Performance NutritionEverything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.Support the Show.

Chris and I talk about my background and motivation for my podcast. I talk about a pediatric arrest I ran that had a huge impact on me. We tend to dehumanize patients in this job to keep our distance, but that is not always the best technique.Emergency standards are standards I have developed working in the ER.One of those standards is to walk slowly through the department. Become mindful. Be intentional and in the moment. Think through the proper order to complete your tasks. It is not your emergency.Mindfulness practices are key to mitigating anxiety and stress. Getting off work on time is key to separating work and life and maintaining that balance. Of course, much of this is outside your control, but control as much as you can. Let the shift go before you get home. Refocus on the rest of your life.Take care of yourself before you take care of patients. Self-care is critical.Overtime is often needed when you need to focus on making money, but this cannot be sustained long term.Daily, consistent discipline will prevent a crisis or emergency down the road.Debriefing and talking through cases can help you process and heal from them.Acute and chronic burnout are different problems and require different solutions. Focus on the factors you have control over. Know your why. A powerful why can overcome a lot of how's.Check out Mind the Frontline below and help their mission to improve lives of first responders:Resilient Response: Self-Care Strategies for Emergency Medicine (mindthefrontline.org)Support the Mission (mindthefrontline.org)Support the Show.

Chris and I talk about my background and motivation for my podcast. I talk about a pediatric arrest I ran that had a huge impact on me. We tend to dehumanize patients in this job to keep our distance, but that is not always the best technique.Emergency standards are standards I have developed working in the ER.One of those standards is to walk slowly through the department. Become mindful. Be intentional and in the moment. Think through the proper order to complete your tasks. It is not your emergency.Mindfulness practices are key to mitigating anxiety and stress. Getting off work on time is key to separating work and life and maintaining that balance. Of course, much of this is outside your control, but control as much as you can. Let the shift go before you get home. Refocus on the rest of your life.Take care of yourself before you take care of patients. Self-care is critical.Overtime is often needed when you need to focus on making money, but this cannot be sustained long term.Daily, consistent discipline will prevent a crisis or emergency down the road.Debriefing and talking through cases can help you process and heal from them.Acute and chronic burnout are different problems and require different solutions. Focus on the factors you have control over. Know your why. A powerful why can overcome a lot of how's.Check out Mind the Frontline below and help their mission to improve lives of first responders:Resilient Response: Self-Care Strategies for Emergency Medicine (mindthefrontline.org)Support the Mission (mindthefrontline.org)Support the Show.