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

By Ross Orpet, Paramedic turned EMS PhysicianEducation

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

October 05When You Can’t Stop the Bleeding: Inside A Massive Trauma Case
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:

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Episode 136: From Tractor Rollovers to Grain Entrapment: A Field Guide to Farm Emergencies

Guests:

Jim Phipps, Critical Care Flight Paramedic, UNC Air Care
34 min
September 28Maternal Trauma Emergencies: What Changes in the Pregnant Patient
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:

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MomBaby.org

UNC Center for Maternal and Infant Health Perinatal Emergency Checklists

Guests:

Dr. Johanna Quist-Nelson, maternal-fetal medicine physician
19 min
September 21Training for the Big Call: How Emergency Teams Can Build Better Performance Under Pressure
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:

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Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.

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UNC Health Trauma Program

TeamSTEPPS

Guests:

Dr. Daryl Johnson, Adult Trauma Medical Director, UNC Health Trauma Program
58 min
September 14From Tractor Rollovers to Grain Entrapment: A Field Guide to Farm Emergencies
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:

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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.

North Carolina Agromedicine Institute

Guests:

Jessica Wilburn, Agromedicine Nurse Coordinator, North Carolina Agromedicine Institute
Maggie Denning, CNA and Outreach Coordinator, North Carolina Agromedicine Institute
52 min
September 07The First 60 Seconds After ROSC: How To Prevent Re-Arrest
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:

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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.
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
36 min
August 31Post-ROSC Care and Pacing: Prove the Perfusion
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
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Jacob’s Resources:

Article with images of false vs true electrical capture:
Kimbrell J, Kreinbrook J, Poke D, et al. False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehosp Emerg Care. 2024;28(7):928-936. doi: 10.1080/10903127.2024.2321287

Link to Scott Weingart's EMCrit podcast episode discussing false positive SpO2 signal without actual capture:
https://emcrit.org/emcrit/tcp-pulse-ox-fail/

Jacobs website with handout version of my slides:
https://jacobmilleracnp.com/slides/

Guests:

Geoff Murphy, Founder and Lead Educator of Master Your Medics
Jacob Miller, paramedic, flight nurse, critical care nurse, nurse practitioner, and DNP
1 hr 7 min
August 24Burn Care in EMS: What Actually Matters in the First 15 Minutes
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
1 hr 3 min
August 17Readiness Beyond the Medicine: Neurodivergence, Pediatrics, and Better Communication
Readiness is about more than knowing the medicine. It’s about creating the conditions for patients, families, and clinicians to feel safer and more capable when the situation is unfamiliar, overwhelming, or high risk.

First up, Boston MedFlight flight nurse Nicole King discusses neurodivergence, sensory overload, and how traditional EMS behaviors can unintentionally escalate distress. She explains why slowing down, reducing stimuli, and involving caregivers can completely change the experience for patients who are struggling.

Then, Ross talks with pediatric flight nurse and Blakery Content creator Christopher Blake about pediatric readiness and why confidence on low-frequency, high-risk calls has to be built before the tones drop. They discuss pediatric emergency care coordinators, agency-wide readiness, and using QA/QI.

In this episode, you’ll learn:
How to recognize when behavior may be the result of sensory overload or difficulty processing the environment
Why pictograms, fidget toys, headphones, sunglasses, and weighted pressure can reduce escalation
How a Pediatric Emergency Care Coordinator can help an agency identify gaps
Why family-centered communication can reduce fear and improve cooperation
How to adapt your assessment when a patient cannot tolerate standard vital-sign monitoring

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.

Pediatric Readiness Assessment

KultureCity

Ben’s Blue Bags and Carter Kits

Emergency Medical Services for Children Innovation & Improvement Center

Birth Vibes: Stories & Strategies for An Empowered Birth, by Jen Hamilton

Guests:

Nicole King, flight nurse, Boston MedFlight

Christopher Blake, pediatric flight nurse and creator of Blakery Content
52 min
August 10Heat Stroke: Recognition, Cooling, and Transport Decisions
What differentiates heat stroke from heat exhaustion? Once central nervous system dysfunction appears, every minute spent at an elevated core temperature increases the risk of permanent neurologic injury or death.

Ross and Will talk with emergency physician and wilderness medicine specialist Dr. Greg Doctor about the full spectrum of heat-related illness – from heat cramps, rash, and edema to syncope, exhaustion, and life-threatening heat stroke.

They discuss how to avoid anchoring on the heat when a patient loses consciousness and what the critical dividing line between heat exhaustion and heat stroke is.

They also examine exercise-associated hyponatremia, drug-related hyperthermia, fluid selection, and the patients who may remain at risk even after they initially appear to recover.

In this episode, you’ll learn:
How to distinguish heat syncope, heat exhaustion, and heat stroke
Why central nervous system dysfunction and an elevated core temperature matter most
How to choose between cold-water immersion, continuous water and fanning, ice sheets, and ice-water slurry techniques
When transport should be delayed for on-scene cooling, and when cooling should continue

Resources:

Wilderness Medical Society Clinical Practice Guidelines for the Prevention & Treatment of Heat Illness: 2024 Update

Unlocking Syncope with Matt Mendes

The Critical Care of the Sick Runner: A Comprehensive Guide with Dr. Whitney Barrett

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.

Guests:

Dr. Greg Doctor, emergency physician and wilderness medicine specialist
48 min
August 03The Pursuit of Mastery: Preparation, Mentorship, and Learning From Mistakes
Most people picture a master clinician as the person in the room who knows every answer. In reality, mastery looks like the opposite, and admitting what you do not know.

Ross talks with FlightBridgeED co-founder Eric Bauer about the “rage to mastery”, the advice that kept him in EMS after a series of difficult calls nearly drove him away, why expertise is perishable, and how ego creates resistance to learning.

Then, Will speaks to Master Your Medics founder Geoff Murphy about a medication error that changed how Geoff understood team culture. They explore what happened, and why psychological safety does not lower the standard.

In this episode, you’ll learn:
Why sustainable learning habits are more valuable than ambitious goals
How experienced clinicians can model vulnerability without undermining their credibility
What to look for in a mentor who will challenge blind spots
How to turn an uncomfortable call into action-oriented preparation for the next 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.

Interested in ABLS Now? Our listeners get 10% off through the end of August.

Guests:

Eric Bauer, CEO and Co-Founder of FlightBridgeED

Geoff Murphy, Founder and Lead Educator of Master Your Medics
49 min

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

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