In this episode, Zach sits down with Dr. Ian Drennan and Dr. Sheldon Cheskes to dissect the newly released 2025 AHA and ILCOR resuscitation guidelines. They break down the evidence, controversies, and real-world implications for paramedic practice.

🔹 How guidelines are actually created 🔹 Mechanical CPR 🔹 Heads-Up CPR

🔹 IV vs IO Access

🔹 Medications 🔹 Defibrillation Science

🔹 Airway Management 🔹 Post Cardiac Arrest Care

In this episode, we explore the science, history, and frontline application of End-Tidal CO₂ (ETCO₂) — a tool that offers real-time insight into ventilation, perfusion, and metabolism. Danny and Rance from DnR explain how paramedics can use ETCO₂ to assess and guide care across multiple patient presentations.

Key Takeaways:

• ETCO₂ is the sixth vital sign — reflecting ventilation, perfusion, and metabolism in real time.

• Capnography vs. Oximetry: SpO₂ shows what was happening; ETCO₂ shows what's happening now.

• Waveform interpretation: Alpha and beta angles reveal underlying pathology like bronchospasm, obstruction, or air trapping.

• Clinical uses:

  • Tube confirmation: Real-time verification in 6 breaths or less.

  • CPR: Values

  • Ventilation: Real-time feedback for rate and volume.

  • Head injuries: Maintain normocapnia; hyperventilate only during herniation.

  • Sepsis, trauma, PE, and DKA: Trending ETCO₂ helps identify metabolic and perfusion problems.

• Practical tips:

  • "Filter first, end-tidal to the sky."

  • Inline sensors outperform sidestream for accuracy.

  • End-tidal is not just for intubated patients — use it with nasal prongs for sedation and respiratory monitoring.

Delta Air Crash: Paramedics on the Frontline of a Mass Casualty Incident In this gripping episode of Critical Levels, host Zach Cantor sits down with Ornge Critical Care paramedics Colin and Darren to discuss their response to the February 2025 Delta crash at Toronto's Pearson International Airport.

From the initial plume of smoke spotted mid-flight to interagency coordination on the ground, they share how training, adaptability, and teamwork guided decisions under extreme pressure. Key Topics: • First impressions from the air and immediate decision-making • Mass casualty triage in an unpredictable environment • The challenges of communication across multiple agencies • The value of leadership, adaptability, and humility under stress • Interdisciplinary and interagency debriefs: lessons learned • Mental health, recovery, and supporting paramedics after major incidents

Takeaway: Mass casualty incidents test every part of the emergency response system. Preparation, communication, and collaboration—not just within one service, but across all responders—make the difference.

What is a paramedic — really?

In this thought-provoking episode of Critical Levels, Zach sits down with Dr. Alan Batt to unpack the evolving identity, responsibilities, and future of the paramedic profession. Together, they explore the disconnect between what paramedics are trained for versus what they actually do, the consequences of outdated education models, and the urgent need for professionalization and system-level change.

They discuss:

• Why current training doesn't match real-world workload

• How we define scope, identity, and autonomy in modern paramedicine

• The concept of career pathways beyond clinical work

• What regulatory independence could look like

• And why it might finally be time for paramedics to "move out of their parents' basement"

Whether you're a frontline clinician, educator, leader, or student, this episode challenges assumptions and sparks a critical conversation about the future of paramedicine in Canada and beyond.

Neonates are one of the most feared patient populations in EMS—and for good reason. In this episode, Zach Cantor talks with Anthony Iacolucci, a pediatric respiratory therapist and paramedic, about how to confidently approach neonatal calls.

Anthony introduces NEO SECRETS, a practical acronym covering the top 10 causes of neonatal illness, and offers insight into assessment, common pitfalls, and key treatment considerations.

NEO SECRETS Breakdown:

• N – Inborn errors of metabolism

• E – Electrolyte abnormalities

• O – Overdose or toxic exposure

• S – Sepsis (the leading cause of neonatal mortality)

• E – Endocrine crisis (e.g., hypoglycemia, adrenal insufficiency)

• C – Cardiac conditions (cyanotic vs. acyanotic presentations)

• R – Recipe or formula mishaps (e.g., dilution errors leading to hyponatremia)

• E – Enteric emergencies (e.g., malrotation with volvulus, gastroenteritis)

• T – Trauma, including accidental and non-accidental injuries

• S – Seizures (often subtle and hard to recognize in neonates)

Key Takeaways:

• Neonates are not small adults or even small pediatric patients—they are physiologically distinct and highly vulnerable.

• Early identification of sepsis, cardiac issues, and metabolic errors can save lives.

• Paramedics should rely on strong assessment skills, detailed history-taking, and high suspicion for uncommon causes.

• Videos, glucose checks, pre-ductal saturations, and detailed caregiver interviews are essential field tools.

• Understanding neonatal physiology, presentation timelines, and risk factors improves both confidence and outcomes.

Why Listen:

If you've ever felt unprepared when faced with a neonatal call, this episode provides a clear, practical, and memorable guide to the top threats to neonates—and how to recognize and respond to them in the field.

In this episode of Critical Levels, we dive into the cutting-edge strategies shaping pre-hospital and emergency department care. Our guests discuss how data-driven decision-making, high-performance CPR, and improved handover processes are revolutionizing patient outcomes.

Key Topics Covered: ✅ High-Performance CPR: The role of real-time feedback, mechanical CPR devices, and quality metrics in improving survival rates. ✅ Data-Driven Protocols: How data influences resuscitation techniques, including push-dose epinephrine, early vasopressor administration, and optimizing CPR pauses. ✅ Seamless Transitions of Care: Addressing the challenges of pre-hospital to hospital handover, minimizing interruptions, and ensuring continuity of life-saving interventions. ✅ Training & Coaching: The impact of structured CPR coaching, debriefing sessions, and real-time monitoring in refining paramedic performance. ✅ Future Directions: Exploring nurse-led ACLS, multidisciplinary teamwork, and technology-driven improvements in emergency medicine.

Key Takeaways: 🔹 Data analysis is critical in refining protocols and enhancing patient survival. 🔹 Effective communication and structured handovers reduce adverse events. 🔹 Continuous training and feedback loops lead to better resuscitation outcomes.

Join us as we explore how collaboration, innovation, and data are shaping the future of emergency medical care.

🔸 Why medics need to understand K9 trauma care

• The overlap between human and canine emergency medicine
• Common injuries in police, military, and search-and-rescue dogs

🔸 MARCH for Canines—What's Different?

• The first "M" stands for Muzzle—securing the dog's "weapon" before treatment
• Understanding the similarities in trauma care between humans and dogs
• Key differences in how canines respond to injury and shock

🔸 Massive Hemorrhage Control—Why Tourniquets Don't Work on Dogs

• Anatomical challenges—why dogs' limbs aren't suited for tourniquets
• When to use direct pressure, wound packing, and hemostatic agents
• Junctional bleeding—where life-threatening hemorrhages happen in dogs

🔸 Airway & Breathing—Why Intubating a Dog Is Easier Than You Think

• How to recognize respiratory distress vs. normal panting
• Why dogs have larger, straighter airways than humans
• Needle decompression for pneumothorax—landmarks and technique

🔸 Transporting an Injured K9—Avoid These Mistakes

• Best positions and vehicles for safe transport
• What paramedics, police, and handlers need to plan for before an emergency

🔸 Shock & Fluid Resuscitation—The Critical Role of Femoral Pulse Checks

• How to assess perfusion in a dog without a blood pressure cuff
• Why EZ-IO is the best choice for vascular access in canines
• When and how to administer fluids, TXA, and blood products

🔸 CPR for Dogs—Does It Work?

• When CPR can save a dog—and when it won't
• How to perform chest compressions correctly
• Naloxone for K9 opioid overdoses—it works, but dosing is different

🔸 Medications & Pain Management—What Paramedics Can Safely Use

• NSAIDs are dangerous for dogs—avoid them in trauma cases
• Opioids, TXA, ketamine, and antibiotics—what's safe and effective?

In this episode of Critical Levels, we tackle frostbite with Dr. Maria Doubova, exploring its pathophysiology, symptoms, and treatment. From outdoor enthusiasts to vulnerable populations, frostbite affects diverse groups. Learn about early early recognition and management of frostbite - from mild frostnip to severe cases requiring advanced interventions - and the latest classification system to improve outcomes in this insightful discussion.

What You'll Learn in This Episode:

What frostbite is and who is most at risk.

Symptoms and early detection techniques.

Frostbite classifications and their significance for prognosis.

Practical pre-hospital and hospital management strategies.

How frostbite overlaps with hypothermia and what to watch for.

Welcome to the first episode of 2025! This month, we're diving into the critical role of Tranexamic Acid (TXA) in pre-hospital trauma care. Dr. Erik Vu, a critical care flight paramedic, emergency physician, and intensivist, joins us to discuss the latest insights and applications of TXA, particularly in dynamic and tactical environments.

From its role in stabilizing clots to its use in mass casualty scenarios, we break down everything you need to know about this cost-effective and life-saving medication. Learn about the benefits of intramuscular (IM) administration, the importance of timely intervention, and how TXA fits into modern trauma care systems.

What You'll Learn in This Episode:

What TXA is and how it works. The history and research behind its pre-hospital use. Why IM administration is a game-changer in tactical and unpredictable environments. Best practices for dosing and administration. TXA's role in mitigating hemorrhagic shock and improving patient outcomes. Practical tips for integrating TXA into your trauma care toolkit.

On this month's episode, we are going to talk about prehospital blood administration with Dr. Peter Antevy

Some topics covered are:

Historical trauma management

Blood

• why
• blood components
• administration ratios
• blood type

Blood administration

• who do we give blood to
• medical vs trauma (blunt vs penetrating)
• elderly vs peds
• vital sign parameters
• when do we administer it
• how do we give it
• IO vs IV (size matters…)
• temperature

Logistics

• how do we get it patient side
• cold chain storage
• temperature management
• training (initial and ongoing)
• minimizing waste

Challenges

• consent
• religion
• administering to females of child bearing age
• transfusion reaction

Blood Adjuncts

• TXA
• calcium
• other

What's the data showing? Next steps