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

Join us for part three of our four part series looking at the physiologically difficult airway. Matt takes us through the approach to severe metabolic acidosis and why these patients are so dangerous to intubate. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Join us for part two of our four part series looking at the physiologically difficult airway. Matt takes us through the different causes of hypotension, why these patients are so dangerous to intubate, and how to resuscitate before you intubate. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

We discuss the following paper and its impact on our prehospital management. Prehospital narrow pulse pressure predicts need for resuscitative thoracotomy and emergent intervention after trauma Schellenberg M, Owattanapanich N, Getrajdman J, et al. J Surg Res. 2021;268:284-290. Enter to Win a FREE Pair of Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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 EMScast15 for 15% Off Frontline Optics Sunglasses

Ross and Matt discuss the importance of preoxygenating hypoxic patients prior to intubating them. This is the first of a 4 part series on the physiologically difficult airways. Link to the makeshift CPAP: https://www.youtube.com/watch?v=yHGMIQBak6A Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Will Berry and Ben Fisher join the show again to teach us about the handheld device on your hip. Do you really know how to use your radio? What do you do if it fails? It's important to talk and think about these things before they happen. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Paramedic Will Berry sits down with toxicologist John Rague to talk about all things carbon monoxide including why snorkels aren't helpful. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses

Ben Fisher, paramedic and NEMSIS guru, joins us to talk about what NEMSIS is and it's importance to the career field. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Glen Andrews has 28 years of experience in medicine but on July 21st, he had to put all of his experience behind and surrender his fate to the care of others. Join us to hear how this event changed him and the insights he has gained from now being on both sides of the gurney. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Lance Ray joins us to emphasize the importance of correct seizure treatment. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

We sit down with pharmacist Lance Ray about dirty epi drips. These are probably our best prehospital option but they aren't silver bullets and they come with downsides. In other words, "we don't call em dirty for nothin." Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Emergency Physician and Toxicology Fellow John Rague joins us to discuss the presentation and management of digoxin toxicity in addition to other cardiac glycosides. Digoxin is not as commonly prescribed anymore thus our teaching on this topic has become less common. But digoxin and other cardiac glycosides are still available and used today so it's still important to understand the recognition and treatment of this toxicity. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

A deep dive on MCI with Will Berry. You have to practice. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Toxicology fellow extraordinaire Alexa Camarena-Michel, MD joins us again to talk about one of sickest overdose patients you may see. Calcium channel blocker and beta blocker overdose patients can be really sick and are often refractory to our standard therapies. Learn how to better manage these patients. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources; Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

A longer one than usual. We take a deep dive into hypothermia with wilderness medicine physician and expert Martin Musi. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Alexa Camarena-Michel teaches us a simple approach to caustic ingestions and more. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Dr. Wright joins us to discuss acute respiratory distress syndrome (ARDS). There has been a lot said about ARDS recently given some of it's similarities to the COVID-19 disease process. That being said ARDS has been around for a long time and is very much its own disease process. We discuss how to define it, how to recognize it, and how we treat it. There are some great media and pictures to help illustrate the points made in this episode on our website. Check out the show notes at https://emspodcast.com/acute-respiratory-distress-syndrome. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Undiagnosed or misdiagnosed diabetes is common because of how vague the symptoms can be. Chief Harper from Denver Paramedics tells us his incredible personal story dealing with his son's diagnoses, his path to becoming an expert on diabetes, and how we should think about this as prehospital providers. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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 month we sit down with Assistant Medical Director Whitney Barrett to discuss the dos and don'ts of calling in for medical control. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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 is still included in the A of ABCs but I got essentially no training on this in paramedic school. I honestly didn’t get much formal training on this after becoming an ED doc either. I just had to bug RTs and ICU docs to learn what I know now. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Airway problems are terrifyring without an approach to solve them. But when you have an approach you can fall back on that with a calm confidence. It’s like we’ve always heard: we don’t rise to the occasion, we fall to the level of training. With trach’s, we unfortunately have to train ourselves. Check out our new website at emspodcast.com! We will have pictures and show notes corresponding to this episode there. Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

We discuss where things go wrong with how we talk to each other and how we can do better. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

EMS physician Whitney Barrett joins us to discuss some of the scariest and emotional calls we can go on and how we can manage these situations better. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Caring for the critically ill pediatric patient is scary for all emergency providers. We discussed our approach to these calls with attending EM/EMS physician Dr. Whitney Barrett. Background 2015 study: review of trip sheets showed wrong intervention, dosing errors in up to 65% of interventions on pediatric calls PREPARE Trial: only 34% of pediatric cardiac arrest patients received epinephrine EMS training in pediatrics is probably inadequate! Human Factors Potential stressors: Math is hard, especially when you’re stressed Paradigm that “pediatric patients are not small adults” may lead providers to overthink resuscitation “Thinking Fast and Slow,” by Daniel Kahnemann: breaks down thought processes System 1: unconscious, second nature System 2: conscious, requires mental effort and focus If we exhaust system 2 with calculations, we can’t effectively focus on patient care and scene control How can we turn system 2 thinking into system 1 thinking? The culture of pride in EMS may prevent some providers from using quick references or “cheat sheets.” There’s no shame in looking something up! Our own stress may contribute to a “hectic scene” as much as the scene itself Don’t automatically “load and go” Early ventilations and compressions—not early transport—save lives Solutions Cheat sheets: have a pocket reference with normal pediatric vitals and doses by volume, which may be specific for your system. Using this sheet on every peds call you run—whether or not you need it—will help familiarize you with its contents for when you really need that info. Pediatric reference systems exist and are designed to help with cognitive offloading Handtevy: estimated weight, vitals, doses, and necessary equipment separated by age. Used by the Denver Health Paramedic Division. Broselow Tape: estimated weight, vitals, and doses listed on a length-based measuring tape. Designed for hospital use, EMS doses often much higher. Old school pearl: tape it flat to the pram so it’s ready for the patient. PediStat App Pearl: age correlates very well with weight, and parents often know the weight! Pre-arrival visualization: on the way to the call, run it in your head based off dispatch information. Pull out your cheat sheet. What is your differential? What treatments might you need? Takeaways Prehospital management of critical pediatric patients needs improvement Prepare for stress by anticipating it. Pediatric reference systems help minimize system 2 thinking and should be used whenever possible. Math is hard, and cheating should be encouraged. Have a cheat sheet and familiarize yourself with it. On the way to the call, consider differentials and treatment plans. If all else fails, pump the brakes. If this were an adult, what would I do right now? Fall back on your ABC’s. Sample Cheat Sheet This Handtevy “badge buddy” doesn’t have vitals, but it does have estimated weight by age, doses by volume, and airway adjunct sizing. It’s also color-coded and easy to follow. Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Maria Moreira joins us to to discuss the intricacies to managing penetrating neck wounds. There are a lot of important structures in the neck and damage to these structures are often life threatening and require quick action to stabilize. We break down how to organize these structures in your mind and develop a treatment plan based on what you're seeing on exam. We'll also take it one step further and discuss how we're going to care for these patients once they hit our doors in the ED. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

First and foremost, we would like to thank all pre-hospital providers for the work you do. You are all underpaid, understaffed, and under appreciated. However, the unsung work that you do matters now more than ever. We go to work every day in order to be there when the public needs us. Much of the focus as of late has been on COVID. And probably rightfully so. But patients continue to have MI’s, strokes, overdoses and many other emergencies. And these emergencies still deserve our excellent care and diligence not to miss. So although we plan to have another special-edition, COVID-update episode we don’t want to neglect these other emergencies. So let's talk about Large Vessel Occlusions. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Ep. 2 Large Vessel Occlusion (LVO) Show Notes First and foremost we would like to thank all prehospital providers for the work you do. You are all underpaid, understaffed, and under appreciated. However, the unsung work you do now more than ever matters. We go to work every day in order to be there when the public needs us. Much of the focus as of late has been on COVID. And probably rightfully so. But that being said, patients continue to have MI’s, strokes, overdoses and many other emergencies. And these emergencies too still deserve our excellent care and diligence not to miss. So although we plan to have another special edition COVID update episode soon we don’t want to neglect these other emergencies. This month we talk Large Vessel Occlusions. Endovascular Stroke therapy (EST) for large vessel occlusion (LVO) - This is the hottest therapy since PCI - 12 studies since 2013, 5 studies in 2015 alone https://rebelem.com/endovascular-therapy-for-acute-ischemic-stroke-the-new-shiny-toy-in-stroke-care/ For a nice review of all of the studies and evolution of endovascular therapy visit: How is EST performed? A catheter is guided through one of the femoral arteries and up through the carotid and into the distal internal carotid, anterior cerebral artery or the middle cerebral artery A clot retrieval device is fed through the catheter in order to retrieve the clot Unlike tPA which has only shown very marginal benefit in just a few studies that were admittedly methodologically flawed. EST has recently had multiple strongly positive trials showing impressive benefits (although these benefits are likely over estimated, see the link above for a deep dive on the researches strengths and weaknesses) Who Qualifies for EST? Similar to the early days of PCI for myocardial infarctions when cath lab centers were farer and fewer between Will likely vary based on your stroke center and may change with future studies so make sure you stay up to date with your local protocols. Initial studies looked at less than 6 hour time window and is what the American stroke guidelines currently recommend. A lot of places have started pushing this time window further out and locally here we us a cut off of less than 24 hours Initially studies for all comers with stroke receiving EST found no benefit It wasn’t until they identified a subset of patients with Large Vessel Occlusions (LVO) that they began to see these impressive benefits An LVO is defined as clot located in either the distal internal carotid, proximal anterior cerebral artery (ACA), or the proximal middle cerebral artery (MCA) Not every stroke center has the capability to perform EST What is the timeline to qualify for EST So do we need to start re-organizing our transport priorities and transporting all of our suspected strokes to EST centers similarly to how we transport all of our STEMI’s to cath centers? With STEMI we have a clear diagnostic tool with our EKG to determine if somebody needs the cath lab. In order to know for sure if our patient would need EST we would need a CT scanner. And not just CT but also the ability to do CT with contrast in order to see which vessel the clot is in. If there is even a clot at all. Given so many mimickers of stroke on a very small percentage of patients evaluated for concern for stroke actually end up having a stroke Which brings us to the second point of why we don’t want to start transporting to only EST centers: Only a select number of stroke patients, those with clots in the large proximal vessels, will benefit from this therapy. It wasn’t until later trials when they narrowed the patients they were treating to those with identified LVO in the arteries mentioned before: distal internal carotid, proximal ACA, and proximal MCA that they started finding benefit. It turns out that only 1 in 770 of stroke patients will have an occlusion meeting criteria for EST. And that's in patients who WE KNOW are having a stroke. Can you imagine what that number would be if we included everyone we just suspected of having a stroke? We would overwhelm the hospital. Early trials from 2013 looked at utilizing this therapy for all comers with stroke and found no b

We talk about toxidromes with emergency physician and toxicologist, Dr. Janetta Iwanicki. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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

Matt Mendes and Ross Orpet talk about why they started this podcast. Enter to Win a FREE Pair of Frontline Optics Sunglasses EMScast15 for 15% Off Frontline Optics Sunglasses Resources: Want to stay ahead of the top 1% in EMS and build real confidence in the field? 👉 Book a call to get personalized guidance, improve decision-making under pressure, and grow your skills as a paramedic: 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