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 [email protected] 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

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 [email protected] 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

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-

Catch up with us after the show

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

Guest/Cast/Crew information-

Guest- Melody Bishop, RRT, CCAA

Host- Ross Orpet, Will Berry 

Catch up with us after the show

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!

Resources

Guest/Cast/Crew information-

Gear We Like

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.

Gear We Like

Guest/Cast/Crew information-

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 [email protected] before August 15th.

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.

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 [email protected] and we can chat about whether the course might be right for you.

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. 

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.

Gear We Like

Guest/Cast/Crew information-

Books We Recommend