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Paramedic training is over, you’re in the front seat now. Whether day 1 or day 1,000 you can’t shake the fear you’re underprepared. You were taught to systematically decide if A... do B. But what if “A” wasn’t in the book? The truth is each emergency call is too unique to teach the right response to every situation. We need to go beyond algorithmic thinking and understand deeper principles, the WHY behind the algorithm. When every decision counts you want to rely on a framework that will guide you when things don’t make sense. Loud & Clear: EMS Guiding Principles is your resource to build that framework. Through discussions with experts, review of evidence-based best practices, and real-world case studies we teach you one step past what you learned in paramedic school. But all of this advanced education is connected back to the guiding principles that answer the question- “at the end of the day, what actually matters to the patient I have in front of me?” Our mission is to elevate your practice and help you improve patient outcomes in every emergency situation. You may not feel ready, you may not feel like you know enough, but by understanding the guiding principles of emergency medicine you can become an expert EMS clinician. Because what you do matters.
Loud & Clear: EMS Guiding Principles is an EMS Cast LLC production
Episodes
2 hours ago
2 hours ago
51 min
Your severe head injury patient is altered and hypertensive. Do they need fluid at all, and if so, which one? And in cardiac arrest, are you only restarting the heart, or is getting blood to the brain just as important?
Matt talks with Dr. Peter Antevy about why plasma may help rebuild the glycocalyx, the protective lining of blood vessels that sheds after trauma, and why he believes the earliest place to give it is EMS.
Then Ross talks with Bruce Hoffman about a swine study testing whether nebulized nitroglycerin during CPR can improve blood flow to the brain.
This episode also covers syndecan, cerebral edema and crystalloid, the EPIC TBI study, plasma versus whole blood, point-of-care TBI biomarkers, pulmonary vascular resistance during cardiac arrest, and why EMS clinicians need a seat at the research table.
In this episode, you’ll learn:
- Why Dr. Antevy's agencies are moving toward running plasma in slowly for TBI
- How plasma alone may bridge some bleeding patients who don't need red cells
- Why carotid blood flow dropped after epinephrine in the nitroglycerin study
- The new questions raised about vasopressors and flow to the brain
Resources:
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Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.
Just have a question and want some personalized help? Book a free coaching call with us.
Nebulized Nitroglycerin Improves Carotid Blood Flow During Cardiopulmonary Resuscitation in a Swine Model of Cardiac Arrest (Kelly et al., Prehospital Emergency Care, 2025)
EPIC TBI study results (Spaite et al., JAMA Surgery, 2019)
Guests:
Dr. Peter Antevy, MD, EMS Medical Director and Founder and Chief Medical Officer of Handtevy
Bruce Hoffman, MSN, RN, CFRN, FP-C, Critical Care Transport Nurse with FlightBridgeED
Oct 19, 2026
Oct 19, 2026
15 min
You just handed off a trauma patient everyone in the room knows won't survive. What happens to them after you leave? Where does their family get to say goodbye?
Will talks with Amie Lemire, Director of Hospice at UNC Health, about a program that brings hospice into the medical center. Instead of dying in a loud, fast turnover emergency department, critically injured patients can move to comfort care within hours, with a team supporting their families and the clinicians caring for them.
This episode also covers the ED direct-admit-to-hospice pathway, the moment a trauma team pivots from resuscitation to comfort care, the 10-bed hospice home in Pittsboro, 13 months of bereavement support for families, and the moral injury clinicians carry after these deaths.
In this episode, you’ll learn:
- Why organ or body donation can take hospice off the table
- How two hospice RNs stationed in the hospital from 8am-8pm can reach the bedside within 1-2 hours of a referral
- Why the team may stay at a family's side without formally enrolling the patient, when only hours remain
- Why inpatient hospice under Medicare is built for active crisis symptom management
Resources:
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Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.
Just have a question and want some personalized help? Book a free coaching call with us.
Guests:
Amie Lemire, Director of Hospice, UNC Hospice
Oct 12, 2026
Oct 12, 2026
14 min
A trauma patient is hypotensive. Is it hemorrhage? Tension pneumothorax? Cardiac injury? Neurogenic shock? In the first few minutes, the differential can get wide fast, but some causes need to stay at the very top of the list.
Recorded at UNC Chapel Hill’s May Day Trauma Conference, Will talks with emergency physician Dr. Maglin Halsey-Nichols about a principle-driven approach to shock in trauma. She explains why hemorrhage should be assumed early, how shock can continue to worsen even after bleeding begins to be controlled, and why trauma resuscitation has to account for more than just blood pressure.
This episode also covers manual blood pressure, shock index, whole blood, minimizing crystalloid, permissive hypotension, TXA, pelvic binding, and the less common causes of traumatic shock that can look very different at the bedside.
In this episode, you’ll learn:
- Why shock index may help identify a patient who needs early blood transfusion before hypotension develops
- How hypothermia, acidosis, coagulopathy, and hypocalcemia can keep hemorrhagic shock spiraling
- Why neurogenic shock may look different from most other trauma shock states, including relative bradycardia
- Why asking how the trauma happened can uncover an underlying medical emergency such as sepsis or seizure
Resources:
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Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.
Just have a question and want some personalized help? Book a free coaching call with us.
Episode 139: When You Can’t Stop the Bleeding: Inside a Massive Trauma Case
Guests:
Dr. Maglin Halsey-Nichols, Emergency Medicine Physician and Assistant Director of the Emergency Medicine Residency at UNC
Oct 5, 2026
Oct 5, 2026
33 min
A mangled extremity, uncontrolled bleeding, bad weather grounding every helicopter nearby, and a trauma center nearly an hour away. Sometimes the biggest challenge is figuring out what to do when the ideal plan is no longer available.
Ross talks with critical care flight paramedic Jim Phipps about a severe farm-auger injury that pushed
multiple teams to adapt in real time. Jim walks through how the responding EMS crew, local hospital, flight team, and receiving trauma center each had to solve a different part of the problem while keeping the patient moving toward definitive hemorrhage control.
This episode covers tourniquet reassessment during resuscitation, wide-band and junctional hemorrhage control, hypotensive resuscitation, whole blood, contingency planning, and the communication required when a team realizes its current strategy is not going to work. Jim also explains the workable solution that helped get this patient to the operating room alive.
In this episode, you’ll learn:
- Why a tourniquet that controlled bleeding initially may need to be tightened again
- How wide circumferential compression can help when a tourniquet no longer has enough usable tissue to work with
- What “accuracy, brevity, and clarity” sounds like when a resuscitation team needs to change plans quickly
- Why asking yourself for 3 things that went well and 3 things to improve can make a post-call reflection more useful
Resources:
Want more? Sign up for our weekly newsletter, The Confidence Dispatch.
Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.
Just have a question and want some personalized help? Book a free coaching call with us.
Episode 136: From Tractor Rollovers to Grain Entrapment: A Field Guide to Farm Emergencies
Guests:
Jim Phipps, Critical Care Flight Paramedic, UNC Air Care
Sep 28, 2026
Sep 28, 2026
18 min
Pregnancy can make even experienced clinicians second-guess decisions. Can you image the patient? Can you cardiovert? Should the trauma assessment change? And at what point does the fetus become part of the resuscitation?
Will talks with maternal-fetal medicine physician Dr. Johanna Quist-Nelson about what matters when caring for a pregnant trauma patient, where fetal assessment fits into the trauma survey, how pregnancy changes positioning and oxygenation goals, why necessary diagnostic imaging should not be withheld, and what clinicians should understand about maternal cardiac arrest and resuscitative hysterotomy.
She also addresses the emotional impact these rare, high-stakes cases can have on families.
In this episode, you’ll learn:
- Why bleeding may be an important clue after trauma even when the pregnant patient appears stable
- How lateral uterine displacement can improve venous return without compromising chest compressions
- Why an unstable arrhythmia in pregnancy should not automatically delay electrical cardioversion
- What a low fibrinogen level can signal differently in a pregnant trauma patient
Resources:
Want more? Sign up for our weekly newsletter, The Confidence Dispatch.
Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.
Just have a question and want some personalized help? Book a free coaching call with us.
MomBaby.org
UNC Center for Maternal and Infant Health Perinatal Emergency Checklists
Guests:
Dr. Johanna Quist-Nelson, maternal-fetal medicine physician
Sep 21, 2026
Sep 21, 2026
57 min
The hardest calls fall apart when communication is unclear, roles blur, feedback feels personal, and the team starts working around each other instead of with each other.
Today, Ross and Will talk with Dr. Daryl Johnson, Adult Trauma Medical Director for the UNC Health Trauma Program, about what it takes to build teams that can perform consistently under pressure, how leaders can manage disagreements without shutting down valuable input, and why relationships built during ordinary shifts matter.
Dr. Johnson also shares how UNC uses shared processes, simulation, video review, coaching, and deliberate repetition to create consistency across an ever-changing team, and why excellence has to become something clinicians practice on ordinary cases rather than something they hope to switch on for a big one.
In this episode, you’ll learn:
- What a question or disagreement from a teammate may signal about a leader
- How reviewing “game film” can help clinicians recognize their own blind spots
- Why lower-acuity calls are an opportunity to rehearse the habits you’ll need during a resuscitation
- What “smooth is fast” really means when the goal is to reduce chaos
Resources:
Want more? Sign up for our weekly newsletter, The Confidence Dispatch.
Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.
Just have a question and want some personalized help? Book a free coaching call with us.
UNC Health Trauma Program
TeamSTEPPS
Guests:
Dr. Daryl Johnson, Adult Trauma Medical Director, UNC Health Trauma Program
Sep 14, 2026
Sep 14, 2026
51 min
The mechanism behind agricultural emergencies can completely change the risk to both the patient and the responders arriving to help.
Ross talks with Jessica Wilburn, Agromedicine Nurse Coordinator, and Maggie Denning, Outreach Coordinator with the North Carolina Agromedicine Institute, about the injuries and environmental hazards first responders may encounter in agricultural communities. They cover tractor rollovers, livestock injuries, pesticide and fumigant exposure, grain-bin entrapment, hydraulic injection injuries, and machinery involving augers and power takeoff shafts.
The conversation also covers responder safety, including how to recognize when machinery is still energized, why a barn or greenhouse call may involve dangerous chemical exposure, and how local farmers can sometimes be one of your best sources of information.
In this episode, you’ll learn:
- Why farmers often minimize injuries, and why “minor” complaints deserve a closer look
- Why grain bins and manure lagoons can create secondary victims when rescuers enter
- How a tiny hydraulic-fluid puncture wound can threaten an entire extremity despite looking benign at first
- What a first responder should do first when approaching moving farm machinery
Resources:
Want more? Sign up for our weekly newsletter, The Confidence Dispatch.
Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.
Just have a question and want some personalized help? Book a free coaching call with us.
North Carolina Agromedicine Institute
Guests:
Jessica Wilburn, Agromedicine Nurse Coordinator, North Carolina Agromedicine Institute
Maggie Denning, CNA and Outreach Coordinator, North Carolina Agromedicine Institute
Sep 7, 2026
Sep 7, 2026
35 min
The First 60 Seconds After ROSC: How To Prevent Re-Arrest
How do you improve your resuscitation systems beyond the ACLS algorithm?
Will talks with Ian Blanchard, Senior Scientist for Alberta’s provincial EMS system about the “frame of survival” and why rehearsing equipment placement and vector change can make critical actions nearly automatic when the call comes in.
Then, Ross talks with Mike Humphrey of Lethbridge Fire and Emergency Services about what happened when his team reviewed their cardiac arrests and discovered a recurring pattern: post-ROSC hypotension followed by a near 50% re-arrest rate.
Their response was to redesign post-ROSC care around the first 60 seconds to prevent life-sustaining therapies from disappearing during the transition of care.
In this episode, you’ll learn:
- What “doing reps in the clinical gym” looks like when you don’t have access to a high-fidelity simulator
- Why moving a cardiac-arrest patient too early can undermine CPR quality and make resuscitation worse
- What 1 minute blood pressure reassessments can reveal that a single “good” post-ROSC pressure may miss
- Why a vasopressor-dependent patient should stay on the EMS stretcher
- The best time to prepare for vector change, pit-crew roles, and post-ROSC care
Resources:
Want more? Sign up for our weekly newsletter, The Confidence Dispatch.
Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.
Just have a question and want some personalized help? Book a free coaching call with us.
Canadian Resuscitation Outcomes Consortium
Resuscitation Academy
International Liaison Committee on Resuscitation
Episode 133: Post-ROSC Care & Pacing: Prove the Perfusion
Guests:
Ian Blanchard, former paramedic and Senior Scientist for Alberta’s provincial EMS system
Mike Humphrey, Lethbridge Fire and Emergency Services
Aug 31, 2026
Aug 31, 2026
1 hr 6 min
Getting a pulse back feels like a win. Seeing pacer spikes and something that resembles a pulse feels reassuring. But in both situations, the monitor can make you feel better before the patient actually is.
Geoff Murphy of Master Your Medics breaks down the fragile minutes after return of spontaneous circulation. He explains why hypotension deserves immediate attention, how falling end-tidal CO2 can warn that cardiac output is deteriorating, and when fluids can serve as a short bridge to vasopressors.
Then, paramedic Jacob Miller challenges some of the assumptions clinicians learn about transcutaneous pacing. He discusses pad placement, pacing current, ultrasound, pharmacologic support, and why clinicians need to keep reassessing even after they think they have capture.
In this episode, you’ll learn:
- Why an initially normal blood pressure after ROSC can be falsely reassuring
- How skeletal muscle contraction during pacing can create ECG artifact and a false sense of mechanical capture
- What can improve your chances of capturing a patient when transcutaneous pacing is needed
- Why practicing the pacer during routine monitor checks can make a rare, high-stress call much easier to manage
- Want more? Sign up for our weekly newsletter, The Confidence Dispatch.
- Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.
- Interested in ABLS Now? Our listeners get 10% off with code LOUD26POD.
Jacob’s Resources:
Article with images of false vs true electrical capture:
Guests:
Geoff Murphy, Founder and Lead Educator of Master Your Medics
Jacob Miller, paramedic, flight nurse, critical care nurse, nurse practitioner, and DNP
Aug 24, 2026
Aug 24, 2026
1 hr 2 min
Burn patients can create a disproportionate amount of anxiety. The calls are uncommon, the injuries can be visually overwhelming, and it is easy to get distracted by the burn itself.
Ross and Will talk with Mark Johnston, a longtime Advanced Burn Life Support instructor and burn program leader at Regions Hospital, about simplifying prehospital burn care. Mark explains how most burn patients should be approached and why you need to resist the urge to make wound care the first priority.
They also dig into the findings that should make you truly concerned about an inhalation injury, how to estimate total body surface area, and which smaller burns still warrant burn-center evaluation.
In this episode, you’ll learn:
- Which airway findings increase concern for inhalation injury
- Why the simple 125/250/500 mL-per-hour approach can be more useful in the field than calculating a full Parkland formula
- How mechanism changes your priorities in thermal, chemical, electrical, and enclosed-space burns
- How wet dressings and aggressive wound care can increase heat loss or distract clinicians from early interventions
Resources:
Want more? Sign up for our weekly newsletter, The Confidence Dispatch.
Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.
Just have a question and want some personalized help? Book a free coaching call with us.
Interested in ABLS Now? Our listeners get 10% off through the end of August.
The Emergency Mind: Wiring Your Brain for Performance Under Pressure, by Dan Dworkis, MD PhD
Peak Performance Under Pressure, by Stephen Hearns
Episode 109: Understanding the EMS Power Curve
Guests:
Mark Johnston, BSN, RN, TCRN, Burn Program Manager at Regions Hospital