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

Prehospital Blood, Trauma Arrest, Hypertension in Pregnancy, and Diltiazem in Afib with RVR

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 Jarvis
Host- 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

Unlocking the Hidden Keys to Calm Under Chaos: How Simple Tools Like A Checklist Can Elevate Your Care

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

• Episode supplemental blog post- https://emspodcast.com/the-power-of-a-simple-tool-in-high-stakes-environments/ 
• 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 Murphy
Host- Ross Orpet, Will Berry 

Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear
• Website- www.emspodcast.com

 

EXCITING NEWS! FIND OUT WHAT WE'VE BEEN WORKING ON.

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.

Engineering Simplicity in Crisis: Mastering Airway Management Through Systematic Approaches With Dr. Rich Levitan

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 Levitan
Host- Ross Orpet, Will Berry 

Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear
• Website- www.emspodcast.com

The Cost of Saving Lives: Complications Arising from Pre-Hospital Tourniquet Use

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 Li
Host- Ross Orpet, Will Berry 

Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear
• Website- www.emspodcast.co

Why Two Paramedics Watched Their Trainer Nearly Kill a Patient (And Said Nothing): How Lessons From The Aviation Industry Could Have Prevented It

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- Glen
Host- Ross Orpet, Will Berry 

Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear
• Website- www.emspodcast.com

The Art of Managing Agitated Patients

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 Hendley
Host- Ross Orpet, Will Berry 

Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear
• Website- www.emspodcast.com

 

Upper GI Bleed: Rescue Strategies From Recognition to Stabilization

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 Conversations Aren't Black and White: DNR, Advanced Directives, and the Intersection with EMS

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, MD
Host- Ross Orpet, Will Berry 

Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear
• Website- www.emspodcast.com

 

 

BONUS: Wise Guys from FAST24- Allen Wolfe and Michael Frakes On Where We Were, Where We're Going, and How We Get There.

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 Frakes
Host- Ross Orpet, Will Berry 

Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear
• Website- www.emspodcast.com