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

Frostbite is more dangerous than it looks and easier to make worse than you think. In this episode, Ross and Will sit down with Dr. Greg Doctor, a wilderness medicine specialist and emergency physician practicing in the Colorado Rockies, to break down frostbite from the prehospital perspective. Greg walks through field assessment, when to rewarm vs. when to leave it alone, pain management, and when to bypass your local ED for a tertiary care center. Whether you’re running urban calls or wilderness rescues, you may see this and this episode will help inform how you approach cold injury. Want more? Subscribe to The Confidence Dispatch, our free weekly newsletter for paramedics who want to get 1% better every shift: → https://loudandclear.kit.com/d45b012fae Want to go even further? The Paramedic Confidence Builder is a year-long course and coaching community for new medics who want to close the gap between what school taught them and what the job actually demands. Not a lecture series. Not another CE you'll forget by your next shift. Real frameworks for clinical reasoning and mental performance. The stuff nobody teaches you in school. If that sounds like what you've been looking for, book a free 30-minute coaching call and we'll talk about whether it's the right fit. Even if it’s not we’ll give you actionable advice on the call so that you still walk away with something valuable: → calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder

The contaminated airway is one of the most unforgiving calls in prehospital medicine. Blood, vomit, debris — your laryngoscope goes in and you're blind. For decades, paramedics managed this with tools designed for a clean OR and training that never got close to the real thing. Dr. Jim DuCanto decided that was unacceptable. He's the anesthesiologist who invented the DuCanto catheter and SALAD (Suction Assisted Laryngoscopy and Airway Decontamination). Will Berry sat down with Dr. DuCanto at the FASTCAN conference for a conversation. In this episode we cover: - The SALAD technique, step by step - Why paramedic OR training should default to video laryngoscopy - The downsides of SALAD that Dr. DuCanto himself will tell you about - What a new portable suction device does differently Guest: Dr. Jim DuCanto anesthesiologist, inventor of the DuCanto catheter and the SALAD technique Want more? Also subscribe to The Confidence Dispatch — Our free weekly newsletter for paramedics who want to get 1% better every shift: → https://loudandclear.kit.com/d45b012fae Want to go even further? The Paramedic Confidence Builder is a year-long course and coaching community for medics who want to close the gap between what school taught them and what the job actually demands. Not a lecture series. Not another CE you'll forget by your next shift. Real frameworks for clinical reasoning and mental performance — the stuff nobody teaches you in school. If that sounds like what you've been looking for, book a free 30-minute call and we'll talk about whether it's the right fit: → calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder

What if the mistake wasn't your fault... but it's still your responsibility? That's the tension Shay Montgomery sits with every time she talks about the day she flew to a scene without the drug bag. Shay is a flight nurse and educator. At FAST 25, she gave one of the sharpest talks of the conference — not on a procedure or a drug, but on the science of why humans make mistakes and what we can actually do about it. WHAT YOU'LL LEARN: Task Brackets — Your brain bundles repetitive actions into smooth automated sequences. The First Habit Rule — The first habit is permanently ingrained. Old habits lurk underneath new ones and surface under stress. Get it right the first time. Goal-Oriented Stimulus — Don't ask "Do I have everything?" Ask "Where are the things I need?" and physically point to them. The Preceptor Problem — Most preceptors feel unprepared. The goal isn't to make "mini me", it's to create independent critical thinkers. Shift Fatigue — Cognitive function degrades meaningfully at 16 hours. Just Culture — Human error is inevitable. Punishment doesn't fix the system. The guilty already feel terrible. They need peer support and system redesign. RESOURCES: Join our Paramedic Confidence Builder CONNECT WITH US: - Instagram- @emsloudandclear - YouTube- https://www.youtube.com/@EMSLoudandClear - Website- www.emspodcast.com CONNECT WITH SHEA: - TikTok: @flightnurseshay - Instagram: @flightnurseshay

Miss your first intubation attempt and your patient's risk of adverse events jumps sevenfold. By the third attempt? Nearly guaranteed complications. This isn't about your anatomical knowledge or practice hours—expert clinicians fail too. David Olvera, who led national research on intubation checklists, reveals why your brain predictably fails under pressure and what systems actually prevent it. You'll learn the challenge-response checklist protocol that speeds up your intubation time (not slows it down), the HEAVEN criteria's six specific warning signs that predict difficult airways before you attempt, and why dump kits create muscle memory that works in the dark. David shares the story that started his human factors obsession and proves that expertise doesn't protect you from error—systems do. This is operational excellence: building checklists that think for you when tunnel vision sets in. Want more? Also subscribe to The Confidence Dispatch — Our free weekly newsletter for paramedics who want to get 1% better every shift: → https://loudandclear.kit.com/d45b012fae Want to go even further? The Paramedic Confidence Builder is a year-long course and coaching community for new medics who want to close the gap between what school taught them and what the job actually demands. Built by an ER doc who runs medical direction for 5 rural Colorado agencies and has talked with hundreds of paramedics about exactly where that gap shows up. Not a lecture series. Not another CE you'll forget by your next shift. Real frameworks for clinical reasoning and mental performance — the stuff nobody teaches you in school. If that sounds like what you've been looking for, book a free 30-minute call and we'll talk about whether it's the right fit: → calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder Resources Paramedic Confidence Builder - emspodcast.com/program To see the actual checklist - https://www.airmedandrescue.com/latest/long-read/medical-insight-latest-tools-ensure-successful-first-pass-intubation Guest/Cast/Crew information- Guest- David Olvera Host- Ross Orpet, Will Berry Catch up with us after the show - Instagram- @emsloudandclear - YouTube- https://www.youtube.com/@EMSLoudandClear - Website- www.emspodcast.com Books we recommend - The Dichotomy of Leadership - https://amzn.to/4fiCAjN - Extreme Ownership - https://amzn.to/3O1FWfa - Managing the Unexpected: Sustained Performance in a Complex World - https://amzn.to/3V7BwYf - Thinking Fast and Slow - https://amzn.to/4fiJG85 Gear We Like - Good Stethoscope - https://amzn.to/3YJJrf2 - Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn - Notepad for taking notes on calls - https://amzn.to/3Z1X21J

Behind the curve. We've all heard it. Most of us have lived it. That sinking feeling when you're mentally three steps behind where the call actually is. The concept of the Power Curve comes from aviation—pilots need to understand the phases of flight and how the plane will react differently and require different inputs during each of these phases. The same principle applies to your 911 calls. This episode breaks down the exact framework to chunk calls into five critical phases. When you understand phases you understand what is needed during each point of the call and how to stay ahead. How to build if-then statements that eliminate decision fatigue. The psychological safety that lets you reset after screwing up in the apartment. And why 80% of medical errors tie back to the one phase—the hospital handoff. Stop reverting to chaos. Build the system that keeps you ahead. Guest/Cast/Crew information- Guest- Moose and Josh from Alert Medic 1 podcast Host- Ross Orpet, Will Berry Catch up with us after the show - Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Books we recommend - The Dichotomy of Leadership - https://amzn.to/4fiCAjN - Extreme Ownership - https://amzn.to/3O1FWfa - Managing the Unexpected: Sustained Performance in a Complex World - https://amzn.to/3V7BwYf - Thinking Fast and Slow - https://amzn.to/4fiJG85 Gear We Like - Good Stethoscope - https://amzn.to/3YJJrf2 - Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn - Notepad for taking notes on calls - https://amzn.to/3Z1X21J Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: https://calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder 📰 Join our bi-weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae

You're not making mistakes because you're dumb. You're making mistakes because of seven predictable factors—and once you know them, you can control them. Kris Kaull delivered a masterclass at FASTCAN on the hidden forces that cause even experienced paramedics to miss critical information when it matters most. This isn't about memorizing more protocols—it's about understanding the cognitive science behind high-stakes decision-making in emergency medicine. Guest/Cast/Crew information- Guest- Kris Kaull, FP-C Host- Ross Orpet Catch up with us after the show - Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Books we recommend - The Dichotomy of Leadership - https://amzn.to/4fiCAjN - Extreme Ownership - https://amzn.to/3O1FWfa - Managing the Unexpected: Sustained Performance in a Complex World - https://amzn.to/3V7BwYf - Thinking Fast and Slow - https://amzn.to/4fiJG85 Gear We Like - Good Stethoscope - https://amzn.to/3YJJrf2 - Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn - Notepad for taking notes on calls - https://amzn.to/3Z1X21J Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: https://calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae

This episode tells the tragic story of Max McKenzie, a teenager with asthma who died from anaphylaxis despite receiving "standard care." His death led his father, Dr. Ben McKenzie, to develop the AMAX4 algorithm. Educator and critical care transport nurse/paramedic Bruce Hoffman breaks down the algorithm and explains why the combination of anaphylaxis and asthma can be lethal, why IM epinephrine may not be enough, and why this is the time to be aggressive. But this isn't simply about memorizing another algorithm. It's about developing the operational confidence to recognize when standard approaches may fail and override your impulse to "try the book answer one more time." You'll learn to identify time-critical scenarios, build red-flag combination awareness, and make high-stakes decisions without second-guessing yourself. Want to systematically build this decision-making confidence? Discover the Paramedic Confidence Builder at emspodcast.com/program —where we teach the operational skills your school didn't. Guest/Cast/Crew information- Guest- Bruce Hoffman, Associate Professor, Critical Care RN and Paramedic Host- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Books we recommend The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa Managing the Unexpected: Sustained Performance in a Complex World - https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back - https://amzn.to/3YJJrf2 Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn Notepad for taking notes on calls - https://amzn.to/3Z1X21J Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: https://calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae

Struggling to remember every protocol in high-pressure medical situations? You're not alone—and memorizing everything isn't the answer. Join us for this game-changing conversation with Jean Francois Couture, co-founder of Parys Medical, as we unpack the science of habit formation for EMS and healthcare providers. Recorded live at FAST 25, Jean breaks down the "habit loop" (cue, routine, reward) and introduces the concept of the "meta-habit"—a habit of habits that transforms how you access critical information during emergencies. Learn why the best clinicians don't memorize everything but know exactly where to find what they need when seconds count. Discover practical strategies for mental simulation, protocol familiarization, and building muscle memory with your cheat sheets. Jean shares actionable steps including planning your clinical scenarios, scheduling regular practice sessions, and developing unconscious competence through repetition. Whether you're new to EMS or a seasoned veteran, this episode provides a roadmap for achieving clinical excellence through deliberate practice and smart information management. Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: https://calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae

What happens when a 24-year-old woman is found frozen in a tree well after last being seen 8 hours prior, with a core temperature of 62°F (17°C)? In this extraordinary case, paramedic Miles Randell and his team performed 4 hours of CPR in knee-deep snow on April Fool's Day 2014—and she walked away with zero neurological deficits. This wasn't luck. Miles breaks down the critical decision to defy transport protocols and how they managed a failed field intubation when her torso sank into the snow during compressions. The case became a catalyst for building Teaam Aeromedical, a progressive nonprofit wilderness air ambulance saves time, lives, and healthcare dollars. Learn the physiology of hypothermic cardiac arrest, why less intervention is sometimes more, and how to package patients in snow to prevent further heat loss. Whether you work in wilderness medicine or urban EMS, the principles here apply: know the science, challenge protocols when they don't serve your patient, and get them to the right place at the right time. Interested in our Paramedic Confidence Builder course? Check us out at - emspodcast.com Guest/Cast/Crew information- Guest- Miles Randell, Paramedic, Founder of TEAAM Aeromedical, for more go to teaam.ca Host- Ross Orpet Catch up with us after the show - Instagram- @emsloudandclear - YouTube- https://www.youtube.com/@EMSLoudandClear - Website- www.emspodcast.com Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: https://calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder 📰 Join our bi-weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae

What do you do when the anatomy you've memorized simply doesn't exist anymore? When a patient's entire face is gone, and your standard airway management tools won't work? This is where training meets reality. Critical care transport legend Allen Wolfe joins us to dissect a real case, a conscious patient with a self-inflicted shotgun wound—no mandible, no nose, no midface—just open tissue and blood spraying everywhere. This conversation covers the Lefort facial injury classification, why the cervical collar is often more harmful than helpful in penetrating trauma, delayed sequence intubation techniques, and intubating in atypical positions. Allen also explains cerebral perfusion pressure through the Monroe-Kelley hypothesis, and why hypotension can be devastating in traumatic brain injury. But beyond the technical skills, this episode is about leadership under pressure, verbalizing your thought process to your team, and having backup plans A through Z before you need them. It's about deliberate practice and mental simulation so you don't freeze when chaos hits. Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: https://calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae Guest/Cast/Crew information- Guest- Allen Wolfe, CFRN Host- Ross Orpet, MD Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

Discover the difference between resistance (your daily shield built through sleep, nutrition, relationships, and spiritual wellness) and resilience (the anaerobic sprint you can't maintain forever). Recorded on-site at Fast25, James Boomhower, founder of StayFit4Duty, breaks down why the EMS culture of "pushing through" is fundamentally flawed. Using the metaphor of muscle training, he explains that continuing to stress a system without recovery doesn't build strength—it causes injury. The recovery time from a torn mental health muscle is exponentially longer than if you'd simply rested appropriately. With over 20 years in New England EMS including training to become a licensed mental health counselor, James brings a perspective that's desperately needed in emergency medicine. He provides the missing manual for sustainable careers in emergency medicine. In this episode he discusses why the 5 pillars of resilience should really be the 5 pillars of resistance. He shares vulnerable stories from his own journey, including the colleague who grabbed him by the collar to stop him from burning out while helping others, and even some relationship strategies to prevent your worst shift from destroying your home life. Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: https://calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae Resources Learn more about StayFit4Duty and connect with James on instagram at @stay_fit4duty on Instagram Get The Relationship Action Plan Document Supplemental Blog post for this episode Guest/Cast/Crew information- Guest- James Boomhower, LMHC-A, MS, FP-C, NR-P, C- NPT, CCISM Host- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

Ever cried in the ambulance because you felt completely overwhelmed? Sophie Fuller has—and she's done something powerful with that experience. In this raw discussion, the Life and Sirens podcast host shares her most vulnerable stories about impostor syndrome, burnout, and finding your way as a new paramedic. Sophie's path to EMS started in the most unexpected way—from a 39-day hospitalization that included being intubated over the holidays to signing up for EMT school from her hospital bed. But becoming a paramedic brought new challenges: crushing self-doubt, constant anxiety before shifts, and the fear that everyone would discover she was a "fraud." Sound familiar? You're not alone. This conversation dives deep into the psychological struggles that plague EMS providers, especially new medics who lose their support structure after paramedic school. Learn the difference between destructive doubt and healthy doubt, discover cognitive reframing techniques to combat catastrophizing and black-and-white thinking, and understand why bravery means doing things scared. Sophie emphasizes one crucial truth: you cannot fight impostor syndrome alone. So hit play and let’s do this together. **If you're struggling with confidence as a new paramedic, our Paramedic Confidence Builder Course can help. To learn more, reach out via email at [email protected] or through our contact page at emspodcast.com or via DM on IG @emsloudandclear** Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: https://calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae Guest/Cast/Crew information- Guest- Sophie Fuller, EMS, HEMS Host- Ross Orpet Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

Death is the Bottom: Why EMS Must Rethink Opioid Use Disorder Treatment "Nobody told me that the bottom had a basement and the basement had a trap door." This powerful quote from a grieving mother reveals the tragic reality: for patients with opioid use disorder, rock bottom isn't recovery—it's death. Dr. Jason Hoppe, a medical toxicologist from the University of Colorado, joins us to challenge how EMS providers think about opioid overdoses. The one-year mortality rate after an overdose requiring Narcan? A staggering 6-7%—worse than the one-year mortality after a STEMI. Yet we invest far less in these patients than cardiac emergencies. This episode covers the evidence-based treatments that actually work (methadone and buprenorphine have incredibly low numbers-needed-to-treat to save a life), how EMS can initiate life-saving treatment in the field, and why "tough love" and waiting for patients to "hit rock bottom" is a dangerous myth. Learn how just an extra 6-minutes on scene could save lives, why patients on buprenorphine need MORE pain medication during trauma, and how breaking the stigma starts with you. Ready to make a real difference? Discover how EMS providers are uniquely positioned to interrupt the deadly cycle of opioid use disorder. Want to build unshakeable confidence on scene? We have developed a program to help paramedics go from self-doubt and imposter syndrome to calm competent providers others look to in crisis. If you want to learn more about our Paramedic Confidence Builder course reach out via email at [email protected] or through our contact page at emspodcast.com or via DM on IG @emsloudandclear Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: https://calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder 📰 Join our weekly newsletter for exclusive EMS insights, leadership strategies, real-life scenarios, and tools designed to help you stay sharp, confident, and ahead of the curve: https://loudandclear.kit.com/d45b012fae Guest/Cast/Crew information- Guest- Jason Hoppe, D.O. Hosts - Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com