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 train like this? We built the Paramedic Confidence Builder course to teach you to manage high-stress situations just like this through deliberate practice. You don't rise to the occasion; you fall to the level of your training. Visit our website to learn more and reach out through the contact page- https://emspodcast.com/    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. 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 ross@emspodcast.com or through our contact page at emspodcast.com or via DM on IG @emsloudandclear**   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 ross@emspodcast.com or through our contact page at emspodcast.com or via DM on IG @emsloudandclear    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

What do you do when the blood pressure monitor shows a number you don’t like? Most providers hit the button again—but what if it’s real? In this episode, we’re joined by critical care transport specialist James Boomhower from Boston MedFlight, recorded live at the FASTCAN conference in Calgary, to break down modern vasopressor management.   We explore how norepinephrine replaced dopamine as the first-line vasopressor, the evidence behind those changes, and what to do when your patient is on three drips and the pressure still won’t budge. James shares practical, real-world insights from the space between the ED and ICU, where seconds matter and protocols are stress-tested in real time.   Key takeaways include: when to trust your BP reading and act, how to choose and sequence pressors based on evidence and logistics, why norepinephrine reduces arrhythmias and improves outcomes, and when to add adjuncts like steroids, sodium bicarb, or methylene blue. We also explore hidden factors like ventilator settings and underlying causes that can sabotage even the best pharmacology.   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 ross@emspodcast.com or through our contact page at emspodcast.com or via DM on IG @emsloudandclear    Guest/Cast/Crew information- Guest- James Boomhower, LMHC-A, FP-C https://www.stayfit4duty.org/    Host- Ross Orpet   Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

Why do some paramedics stay unshakable under pressure while others crumble on the exact same call? The answer isn't about years of experience—it's about understanding the neuroscience of stress and having the right mental tools.   Cody Winterford delivers an incredible breakdown of the five psychological "circles of hell" that providers face in high-stress situations. Starting with the amygdala hijack that triggers your fight-or-flight response, through the crisis of confidence that makes you question everything you've trained for, to analysis paralysis where you're drowning in information but can't make a decision—each level has specific warning signs and proven techniques to overcome it.   We explore why mental simulation is so effective and why elite athletes and the blue angels rely on it to perform at their peak. We discuss tactical breathing techniques, the power of self-talk and focus phrases (even inappropriate ones!), and how to recognize when life distractions are creating "brain fog" that prevents you from accessing your clinical knowledge.   This isn't theory—it's practical, field-tested mental performance strategies adapted from military and elite athletic training, specifically applied to EMS providers. If you've ever felt overwhelmed on scene, doubted your abilities during a critical call, or watched a partner struggle mentally, this episode provides the framework to understand and overcome those challenges.   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 ross@emspodcast.com or through our contact page at emspodcast.com or via DM on IG @emsloudandclear    Episode Blog Post- The 5 Levels of EMS Mental Breakdown and How to Escape Them   Guest/Cast/Crew information- Guest- Cody Winniford, EMT-P, CCP-P, FP-C @ordinary_ops_medic @alertmedic1   Host- Ross Orpet, Will Berry    Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

What if the evidence hierarchy you learned in school is incomplete? Dr. Eddie Lang, who helped develop the GRADE system now used by WHO and major resuscitation councils, explains why clinical practice guidelines—not RCTs or meta-analyses—should guide your practice decisions.   Join us at FASTCAN 25 as Dr. Lang, who's helped shap guidelines for the World Health Oganization (WHO) and the International Liaison Committee on Resuscitation (ILCOR), dismantles common misconceptions about evidence-based medicine and explains how it has evolved over the years. It's no longer "whatever the study says"—it's now carefully evaluating research limitations, considering patient values, and assessing feasibility, acceptability, and equity. Clinical practice guidelines sometimes get a bad rap but Dr. Lang explains why they ultimately should sit atop the evidence hierarchy.   We also discuss game-changing AI applications in EMS: consolidated electronic health records enabling precision prehospital care, automated documentation, predictive analytics for patient destination, and an AI tool providing evidence synthesis with references in seconds.    Whether you're a paramedic, nurse, or physician, this episode has the power to change how you evaluate and apply clinical evidence.   Subscribe for more evidence-based EMS content that cuts through the noise so that you never lose sight of the forest through the trees.   Guest/Cast/Crew information- Guest- Eddy Lang, MD Hosts- Ross Orpet, Will Berry    Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

Understanding the toxidromes provides you with vital diagnostic tools in high-stakes environments. In this episode, we break down the clinical patterns that define toxidromes- the clusters of signs and symptoms that point to poisoning or overdose. We explore the hallmark features of the most common toxidromes, highlight common pitfalls in recognition, and explain how early pattern recognition changes patient outcomes. But not all symptoms are what they seem. In this episode, we peel back the layers of toxidromes to show how overlapping signs can mislead even experienced providers. From pinpoint pupils to altered mental status, we examine which clues you can trust and which demand a deeper look. Packed with real-world relevance, this discussion will sharpen your clinical instincts and prepare you for the next toxicological mystery.   Guest/Cast/Crew information- Hosts- Ross Orpet, Will Berry    Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

Melody Bishop helps us simplify the physiology of bag-valve-mask (BVM) techniques. This episode highlights common mistakes like insufficient exhalation time, discusses driving pressure, and explains the importance of proper technique to avoid lung injury. We also explore the nuances of endotracheal tube size, laminar flow, and the transition from BVM to mechanical ventilation. From FASTCAN in Calgary this episode will enhance your understanding and skills in respiratory care.   Resources Episode supplemental blog post and show notes Melody’s Free Book on mechanical ventilation  Guest/Cast/Crew information- Guest- Melody Bishop, RRT, CCAA Host- Ross Orpet, Will Berry    Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

Dr. Jeff Jarvis, EMS medical director and host of the EMS Lighthouse Project, delves into the latest emerging EMS literature and guidelines from the National Association of EMS Physicians. We explore best practices for blood use in trauma, up-to-date trauma arrest recommendations, postpartum hemorrhage, and severe hypertension in pregnancy. Additionally, we discuss recent studies on field intubation times, pre-hospital treatment of AFib with RVR, and pre-treating with calcium before diltiazem for patients in AFib. This episode is packed with crucial, evidence-based information for best practices in the prehospital setting. Don't miss out! Website show notes link Episode on YouTube Resources EMS Light House episode on pretreatment with calcium before diltiazem in Afib The Resus Tailor  Guest/Cast/Crew information-Guest- Dr. Jeff JarvisHost- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2

What's the real difference between paramedics who stay calm under pressure and those who panic when everything goes wrong? It's the ability to already know what comes next. In this episode we explore the power of consistency and how one simple tool, often dismissed, can improve patient care and outcomes. Geoff Murphy, founder of Master Medics, sat down with us onsite at FAST25 to discuss how checklists can not only save lives but allow you to remain confident in knowing what is next on scene. Not to mention they're a great training tool as well. Resources The Resus Tailor - https://www.theresustailor.com/ Podcast announcements: Our Paramedic Confidence Builder Program is officially underway. Stay tuned for updates on how everything is going. If you want to join a waitlist to be able join in the next cohort email us at ross@emspodcast.com Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information-Guest- Geoff MurphyHost- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com  

Were have we been? Well, the truth is, we've been incredibly busy working on some really exciting projects. If you're interested in joining the founding members cohort of  the Paramedic Confidence Builder Course reach out to me at ross@emspodcast.com before August 15th. Project #1: Understanding New Paramedic Challenges We launched a research project diving deep into understanding exactly what newer paramedics struggle with as they make that transition from school into the real world of EMS. We all remember that feeling - you graduate paramedic school, you pass your registry, you get your first job, and then... reality hits. The textbook scenarios suddenly become real patients with real families, real emergencies, and real consequences and it turns out none of those patients read the textbook. There's this gap between what you learned in class and what you need to know to be truly confident and effective on the streets. We've been talking to new paramedics, experienced providers, educators, and EMS leaders to really understand where those gaps are. What are the specific challenges? What makes the difference between a new paramedic who struggles and one who thrives? This research has been fascinating, and it's going to inform not just the educational episodes we create going forward, but it's also led us to our next project. Project #2: The Paramedic Confidence Builder Course This is what we're most excited about - we've developed what we're calling right now the Paramedic Confidence Builder Course. This isn't just another continuing education program. This isn’t just a set of pre-recorded lectures. This is about taking everything we've learned from our research and creating a comprehensive program to help bridge that gap between school and street confidence. I'm talking about mentorship, coaching, practical scenarios, decision-making frameworks, and most importantly - building the kind of unshakeable confidence that lets you walk into any call knowing you've got the tools and mindset to handle whatever comes your way. We've got a fantastic group of paramedics signed up for our founding members cohort, and we're about to launch in one week. If this sounds like something that might be a good fit for you, we do have a very short window left and only a few spots remaining in this founding cohort, but f you're interested, send me an email before August 15th at ross@emspodcast.com and we can chat about whether the course might be right for you. Project #3: Continuing Education Credits The third project we've been working on is the ability to get continuing education credits for listening to our episodes. We're currently beta testing this system, and I'm optimistic that we'll have it ready to launch by the end of the year.  Looking Ahead So that's what we've been up to.  The good news is we're back on track. We hope to have our next regular episode released next week, so tune in for some more of that high-level continuing education you've come to expect from us here at Loud and Clear. Thank you again for being such an incredible community. Your support, your feedback, your engagement - it all matters. It's what drives us to keep pushing forward and finding new ways to serve you better. Until next time, stay safe out there, keep learning, and remember - every call, no matter how big or small, is an opportunity to make a difference.

Renowned airway enthusiast, Dr. Rich Levitan, on mastering airway management. Explore his approach to simplifying complex tasks into achievable and believable steps. Every complexity incurs a debt to crisis performance, instead, learn how we can decrease stress and engineer success in crisis performance. Resources YouTube link- https://www.youtube.com/watch?v=UWMJS-pKYKw The Resus Tailor - https://www.theresustailor.com/ Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information-Guest- Dr. Rich LevitanHost- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

We dive into the latest emergency medicine research evaluating the complications following pre-hospital tourniquet use. Dr. Ben Li, an expert in emergency medicine literature reviews a 2023 study titled 'The Cost of Saving Lives: Complications Arising from Pre-Hospital Tourniquet Use,' exploring its implications for EMS providers. From infection to compartment syndrome, we discuss the potential downstream complications and we do so reviewing step by step guide on how to critically appraise current literature. Tune in to ensure your evidence-based care starts in the streets.   01:10 Introducing the Study 03:48 Understanding Study Design and Quality 06:19 Diving into the Study's Context and Background 09:04 Using Appraisal Checklists to Evaluate the Study 10:31 Cohort Study Design and Its Implications 15:31 Selection Bias and Generalizability 22:36 Measurement and Classification Bias 24:45 Understanding Confounding Variables 25:51 Evaluating Study Methods and Follow-Up 27:43 Analyzing Study Results 31:21 Complications and Their Implications 34:33 Multivariable Analysis Insights 36:49 Practical Applications and Future Research 46:24 Final Thoughts   Resources The Resus Tailor - https://www.theresustailor.com/  Critical Appraisal Checklists- https://casp-uk.net/casp-tools-checklists/  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 Books We Recommend The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information-Guest- Dr. Ben LiHost- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.co

A field trainer administers a non-indicated medication while two trainees watch in silence. Sound familiar? In this eye-opening episode, we dive deep into how the aviation industry transformed from a punitive, hierarchical culture to one where crews actively prevent catastrophic errors—and how YOU can apply these same principles on your next EMS shift. Our guest, Glen, a commercial airline pilot and aviation safety expert, shares how the aviation industry has revolutionized itself through such methodologies as just culture, crew resource management, and error prevention tools like the inquiry, advocacy, assertiveness model. We explore how these principles can be effectively applied in our EMS world to improve safety and performance. By the end of this episode, you'll walk away with practical tactics to implement on your next shift, ensuring you and your crew can handle high-stress situations with confidence and competence. Key Concepts Covered: Crew Resource Management (CRM) Just Culture principles Aviation Safety Action Program (ASAP) Power distance in medical teams Human factors in emergency medicine Error prevention strategies Books Mentioned by Glen: Just Culture by Sidney Dekker - https://amzn.to/3Su0A9Y The Myth of Multitasking: How "doing it all" gets nothing done - https://amzn.to/4dAFa4E  Crew Resource Management Practice and Principles- https://amzn.to/3ZIjXzZ Threat & Error Management resources - https://skybrary.aero/articles/threat-and-error-management-tem Other Resources: The Resus Tailor - https://www.theresustailor.com/  This Episodes Blog Post- https://emspodcast.com/what-airplane-crashes-teach-us-about-saving-lives-in-ems-lessons-in-crew-resource-management-and-just-culture-from-the-aviation-industry/  Gear We Like: Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Other books we recommend: The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information-Guest- GlenHost- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

Effective agitated patient management requires a fundamental shift from viewing these encounters as behavioral problems to recognizing them as medical emergencies with underlying pathophysiological processes. By systematically addressing safety, identifying root causes, selecting appropriate pharmacological interventions, and maintaining rigorous post-sedation monitoring, EMS providers can dramatically improve outcomes for these challenging patients. Remember: you cannot talk someone out of a hypoglycemic crisis, hypoxic emergency, or sympathomimetic overdose. When verbal de-escalation fails, it's not your failure as a provider—it's an indication that medical intervention is required to address the underlying pathophysiology driving the patient's agitation. The goal isn't just to control behavior—it's to provide definitive medical care that addresses the root cause of the patient's distress while maintaining safety for everyone involved.   Our guest is Patrick Hendley, a practicing paramedic and an expert in agitated patient management. We'll explore the pathophysiology behind agitation and essential strategies for EMS providers faced with these calls. We'll also examine sedation choices, restraint use, and post-sedation care through a lens of real-world EMS principles. Join us as we look at more than just de-escalation, but understanding and acting effectively and ethically to safeguard everyone involved.   Don't forget to check out our sponsor, The Resus Tailor, for custom bag designs tailored to your EMS needs. Reach out to them at theresustailor.com.    00:00 Introduction to Loud and Clear EMS 00:27 Today's Topic: Managing the Agitated Patient 01:00 Guest Introduction: Patrick Henley 02:17 Sponsor Message: The Recess Tailor 03:01 Case Study: Agitated Patient Scenario 06:04 Understanding Agitation and Safety Principles 08:12 Sympathetic Nervous System and Agitation 10:00 Factors Contributing to Agitation 13:02 Drug Influence on Agitation 19:05 Safety Hierarchy in EMS 30:34 Transport Safety and Patient Management 33:07 Treating Underlying Causes of Agitation 39:08 Managing Patient Anxiety with Fentanyl and Oxygen 39:45 Using Ketamine for Pain Control and Sedation 40:25 Addressing Mixed Presentations: Schizophrenia and Substance Use 41:38 Treating Sympathomimetic Overdose and Psychosis 42:56 The Importance of Post-Sedation Monitoring 43:51 Verbal De-escalation and Benzodiazepines 45:00 Using Time as a Tool for Postictal Patients 46:11 Understanding Benzodiazepines and GABA Receptors 47:59 Antipsychotics and Ketamine: When Benzos Aren't Enough 59:17 The Role of Physical Restraints in Patient Management 01:08:43 Effective Handoff and Continuity of Care 01:18:11 Final Thoughts and Core Principles   Resources The Resus Tailor - https://www.theresustailor.com/ The Art of Managing Agitated Patients Supplemental Blog Post - https://emspodcast.com/the-art-of-managing-agitated-patients/ Gear We Like 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 Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Guest/Cast/Crew information-Guest- Patrick HendleyHost- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com  

Let's delve into the critical steps required to manage an upper GI bleed in the field. This episode breaks down the recognition of risk factors, vital airway and circulation interventions, and best practices for transporting and notifying the hospital. We discuss important historical clues and provide insights on airway handling and circulatory support. Learn how to navigate these time-sensitive emergencies with speed and thoroughness to improve patient outcomes.  00:30 Host Introduction and Episode Overview 01:22 Recognizing Upper GI Bleeds 01:45 Sponsor Message: The Resus Tailor 02:38 Four Clues to Identify GI Bleeds 06:17 Critical Questions for GI Bleed Patients 09:47 Airway Management Strategies 15:21 Circulatory Support and IV Access 19:26 Medication Considerations 22:28 Transport and Hospital Notification 23:41 Conclusion and Viewer Engagement   Resources Get 10% off FAST25 with promo code- loud&clear The Resus Tailor - https://www.theresustailor.com/ Website show notes link Other episodes you might like: Podcast announcements Survey- Help us learn what content you want Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information-Guest- Host- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com

These challenging scenarios represent opportunities to provide truly patient-centered care at life's most vulnerable moments. By combining your medical expertise with thoughtful communication, you can help ensure patients' wishes are honored while supporting families through difficult transitions. In this episode we dive into the complex ethical and legal dilemmas faced by EMS providers when arriving on scenes involving Do Not Resuscitate (DNR) and goals of care forms. With special guest Dr. Daniel Markwalter, an emergency physician and hospice/palliative care expert, the discussion touches on understanding the importance of these forms, the challenges of making decisions without clear directives, and strategies for effective communication with family members when they suddenly disagree with the form. This episode provides valuable insights and practical advice for EMS professionals who can be faced with these sometimes challenging scenarios.   00:00 Introduction: The Ethical Dilemma in EMS 00:49 Sponsor Message: The Recess Tailor 01:53 Case Study: Evening Shift Dilemma 03:33 Expert Insights: Dr. Daniel Mark Walter 04:40 Understanding Hospice and DNR 09:48 Advanced Directives and Code Status 19:20 Challenges with Comfort Care and Advanced Directives 26:19 Aligning Medical Knowledge with Patient Goals 28:34 Understanding Goals of Care 29:03 Respecting Autonomy in Medical Decisions 30:02 Effective Communication with Families 31:45 Navigating Family Overrides in Critical Moments 32:36 Legal Aspects of Surrogate Decision Making 36:00 Exploring Illness Understanding and Prognosis 45:46 Symptom Management in Palliative Care 49:43 Final Thoughts and Summary   Resources Get 10% off FAST25 with promo code- loud&clear The Resus Tailor Todays Episode Show Notes Survey- Help us learn what content you want Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information-Guest- Daniel Markwalter, MDHost- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com    

Get 10% off FAST25 with promo code- loud&clear. In this special episode of Loud & Clear: EMS Guiding Principles, we learn from the wisdom of 2 industry leaders with nearly 70 years worth of combined experience, Allen Wolfe and Michael Frakes. This episode explores the evolution of EMS education, effective training strategies, and the importance of lifelong learning. Whether you're an educator, a learner, or just passionate about EMS, you'll find valuable insights on how to improve your skills and knowledge. Enjoy this bonus episode filled with expert advice, engaging discussions, and practical tips to level up your EMS game!    00:00 Episode Quotes 00:38 Welcome to Loud and Clear EMS 01:19 Upcoming Fast 25 Conference 02:10 Meet the Guests: Allen Wolfe and Michael Frakes 04:20 Allen's Background and Experience 05:41 Changes in Clinical Education 07:51 Future of Education: VR and Edutainment 09:09 Advice for Education Directors 11:34 Field Training Officer Tips 15:08 Choosing the Right Workplace for Critical Care Experience 16:31 Real-Life Trauma Cases and Lessons Learned 19:36 The Importance of Self-Education and Lifelong Learning 21:48 Michael Frakes Introduction- Insights from a Career in Critical Care Transport 22:44 Advancements and Challenges in Medical Education 27:59 Final Thoughts and Key Takeaways Resources The Resus Tailor - https://www.theresustailor.com/ Get 10% off FAST25 with promo code- loud&clear Survey- Help us learn what content you want Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information-Guest- Allen Wolfe, Michael FrakesHost- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com  

Let's discuss the intricacies of evidence-based medicine (EBM) with Dr. Ben Li. The conversation dives deep into understanding different types of medical studies, their hierarchies, and how EMS providers can apply them to their practice. The episode covers evaluating research, the importance of study design, confounders, sample size, and how to discern the relevance and applicability of research findings. Dr. Li provides practical advice for critically appraising literature and emphasizes doing so in a way that is personally relevant to the listener's practice. This episode is essential for anyone in EMS or emergency medicine looking to deepen their understanding of medical research and how it impacts patient care. Enter to win Airpods, Cric-a-lot, and a belt buckle! Resources that can help Critical appraisal guides: https://casp-uk.net/casp-tools-checklists/ (my personal favorite) https://jbi.global/critical-appraisal-tools Reporting guidelines (similar to appraisal guides, but more are standards for the investigators to use and follow): https://www.equator-network.org/reporting-guidelines   00:00 Introduction and Priorities 00:34 Show Restructure Announcement 01:42 The Evolution of EMS Practices 03:57 Understanding Evidence-Based Medicine 05:23 Interview with Dr. Ben Lee 07:20 Approaching and Appraising Medical Studies 08:14 Challenges in EMS Research 13:47 Study Design and Hierarchy 31:33 Applying Research to Practice 39:26 Final Thoughts and Takeaways   Resources The Resus Tailor Enter to win Airpods, Cric-a-lot, and a belt buckle! Website show notes link Other episodes you might like: Podcast announcements Survey- Help us learn what content you want Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J Sunglasses - https://frontline-optics.com/discount/EMSCAST15 Books we recommend -  The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Guest/Cast/Crew information-Guest- Host- Ross Orpet, Will Berry Catch up with us after the show Instagram- @emscast Twitter- @ems_cast Website- www.emspodcast.com