Former paramedic and has been an ER physician for 7-8 years

He pursued emergency medicine after his experience as a paramedic because he feels it is more in line with his personality 

We talk about how emergency medicine checks a lot of exciting boxes that we enjoy

Adam talks about his burnout symptoms as well as how he course-corrects

He talks about symptoms like lacking as much compassion/empathy as he should have. So he corrects by talking with his wife, focuses on getting enough sleep etc

He has let go, to some degree, of all the “techniques” we learn to combat burnout and refocused on his “why” – he knows his purpose. He was called by God to do this job

“Without question, I was called to be in this position by God – it changes everything”

Part of the difficulty of the ER is the sheer volume of people we see on a given day, in a lot of ways, we are managing a lot of mental health conditions in that volume – it can be an opportunity and a gift rather than just viewing it as something to get through. Seeing people as human beings

This perspective can help us avoid cynicism – I’ve found that assuming good intentions on the part of everyone I encounter during the day goes a long way towards avoiding cynicism and taking better care of patients

We must intentionally hold on to the victories, the grateful patient, the lifesaving situation 

When you look for the good, you tend to find it

We talk about setting tone for the rest of the staff in the ED

We talk faith in emergency medicine as Christians, it has everything to do with everything that we do in life and in the job

“I would have chosen an easier job with an easier route to get to it if it wasn’t for God”

“The hope I have in Jesus sustains me”

Why do awful things happen to good people

Free will leads to the world we see and proves that we are not God, yet we are called to His standard

The potential of every human to do self-seeking, evil is why we see some of the horrible things we see, the answer is where do we take these burdens

I discuss my view of free will and its ramifications and our mission on earth as Christians

“Should only bring patience and kindness and hope to an interaction with another human who is suffering”

Support the show

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Give the escalating patients some room, you don’t have to be within arm’s reach

I talk about what a bad code blue looks like and what a good code blue looks like and how this translates to running a good code grey

Assign roles, we don’t have to surround every aggressive patient with a ton of people

Don’t join in the fight or flight mindset that the patient may be operating in

We talk about who should be lead in these situations and how we should be handling behavioral health emergencies when they escalate

We deal with staff and nurses leaving the field related to these negative interactions, so part of the goal needs to deal with the emotional toll it leaves on the healthcare individuals involved

Sometimes patients don’t choose the ideal plan that we may want for them, but we can’t let this burn us out and instead, focus on making a great alternate plan that will serve them

Josh shares a great personal story where he went above and beyond to help a grieving family member that still remembers him from a decade ago

Sometimes all we can do is plant a good seed and the harvest is much later

Great customer service is an important concept, respect and dignity, empathy and understanding

Fight to understand, not fight to win

We have to frequently check our bias, we can miss opportunities and even medical emergencies if we write off a patients behavior as just a behavioral issue

We cannot help others until we take care of ourselves

Hydrate, use the bathroom, eat while on shift

We are all at risk of developing cynicism from negative encounters, so we have to be intentional of seeing the good

Support the show

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Josh has 20 years in Public Safety

Currently doing crisis prevention instruction

We often don’t get any education in med school or PA school in how to communicate well with patients or how to de-escalate their behavior

Code greys are the behavior health emergency response; someone has some concern that a patient is escalating to potentially violent behavior and a team will respond

Staff safety is priority

We are there to provide excellent medical care, if it’s safe to do so

We recommend calling code greys earlier to avoid worsening scenarios 

Code grey assures staff safety then de-escalation of the patient

Recognizing when you need help with patient interaction from some other staff member is important

Typically, negative behavior is a result of an unmet need or want

Rationally detach

Give people options, this helps give them a measure of control when they feel out of control

Get consent to do a physical exam, taking that extra few seconds to explain what you’re doing and getting that quick permission goes a long way

We forget that we ignore many social norms in the ED, patients may not be used to this

Always introduce yourself

A huge component to de-escalation of patients with negative and violent behaviors is that, if not done properly, they are a primary source of burnout. They become a huge negative experience that it sticks with you, not to even speak of the potential for an injury. Avoiding these negative experiences at all costs will be key to thriving in emergency medicine

Josh talks about a severe ankle injury he sustained and how he found a way to keep helping people anyway. He talks about how he strived to get the struggling people back connected to community. He helped them re-establish trust in others so that they could accept help

We talk about the resources available for financially struggling patients

Support the show

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Lucas gives his pitch for why it is still worth it to be a physician - it’s one of the best jobs in the world but you have to have the ability to adapt to change over time

Being a physician still allows you a rewarding, stable and consistent job. A comfortable lifestyle. Job portability

As a PA, this can be even better because you can switch between specialties

Our variable schedule in the ED has its cons but it has a lot of pros as well

We talk about things that we find rewarding in emergency medicine

Even the non-work-related rewards when we often do nothing at all but reassure our family, our friends is fulfilling 

The cascade from relieving anxiety and saying “you are okay” is powerful

A brilliant ER mind said “Don’t just do something, stand there”

If you are well, aggressive medical interventions are more likely to harm you than help you

Take care of yourself, take care of your relationships, the lone wolves die, humans need other humans to survive

In your journey in a career that is very difficult and very easy to burnout, the rewards are much more magnified on the other side. The rewards are much more in your control than you think. With the right mindset you can change how rewarding your career will be

This is an amazing setting, you have one of the coolest jobs in the whole world

What other job is there where you see people on the worst day of their lives, save a life and can allow other people’s lives to touch you

There is an honor to be there on someone’s worst day

Intentionally look for the positive, it is there

Support the show

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Longevity in a tough field is something you need to consider as well as the right mindsets that keep you there – be intentional about being grateful

Lucas gives some advice in doing triage shifts and focusing on the good people you have the privilege to interact with and trying to be intentional about not focusing on the mean, angry patient

Intentionality behind the things that improve your well-being are more important to prioritize than you might think 

Allow your family, significant other to help you

Fatherhood and dual income houses are more the norm now so both parents have to work toward raising children and working

Lucas gives advice to the new ER physician

The busier you are, the more stressed you are, the more you need to maintain hobbies

The PA profession has done a good job of setting people up for success with having a good work and life balance

Community is super important to cultivate, the lone wolf dies

It can be easy to justify allowing relationships to wane when you are busy in medicine and education, but this cannot be put off forever

Break the pattern of pushing off community in favor of career

Support the show

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

ER physician for 15 years

He talks about this path into med school and emergency medicine as his first choice

He likes the challenge, lack of predictability and wide scope of problems we must solve. We have the honor to accept patients when no one else will

Lucas talks about how the term emergency medicine is almost becoming antiquated when we are doing acute, undifferentiated care

Some of the care is emergencies, but not all. And that’s probably for the best so we don’t get burned out

He talks about burnout and how we should focus on how to manage it when it happens as opposed to how to prevent it all the time

You need to accept that burnout will happen, so you don’t have an expectation mismatch

Being aware of your own burnout is key to correcting it

Optimizing the other things in your life outside of work like exercise, nutrition, community is key

Be intentional about focusing on the enriching case, appreciative patient, positive conversation you have throughout the day. If you look for the positive you will find it and then do whatever you need to do to get it in your long-term memory

Lucas talks about gratitude and how this requires intentionality as well

We talk about how much to share with spouses 

We talk about the role of the clinician in the ED and how we have a lot of things to manage that other staff may not see

We talk about how to manage our limited resources

Support the show

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Leave work on time
•David’s story: a skilled, compassionate paramedic who deeply connected with patients, especially during psychiatric crises.
oStruggled to separate work from life.
oRelied on alcohol as a coping mechanism, which ultimately cost him his life.
•Core lesson: In emergency medicine, you must leave work at work—emotionally and physically—otherwise burnout and unhealthy coping are inevitable.
•Healthy separation:
oBalance connection with patients while avoiding over-identification.
oRemember: “It is not your emergency.”
•Practical strategies to get off on time:
oCheck labs/imaging in real time.
oComplete charting as you go.
oPlan handoffs 1–2 hours before end of shift.
oControl what’s controllable—systems, shift crossover, advocate for better staffing.
•Mental discipline:
oSet down burdens from tragic or unjust cases (e.g., drunk drivers, preventable deaths).
oFind something greater than yourself (faith, higher power, or another anchor) to release what you can’t control.
•Work–life balance:
oCreate a clear line between work and home (physical transition, dedicated space, or ritual).
oAccept that some seasons demand more grind, but don’t let it become a lifestyle.
oYour family will notice the time you miss more than your employer ever will.
•Identity check:
oYou are not your job title; resilience and character matter more.
oOver-identifying with work justifies staying late and sacrificing home life.
•Universal takeaway: No matter the field, burdens from work will bleed into family life unless you intentionally lay them down. Getting off on time = preserving resilience, family, and long-term health.

Chapter 3: Take Care of Yourself Before You Take Care of Others
•Past struggles:
oPrioritized school and work over health.
oPoor sleep, binge eating, energy drinks, inconsistent workouts.
oLack of discipline → foggy brain, poor performance as a paramedic.
•Core principle:
oYou cannot care for others well if you neglect yourself.
oIn EMS/ED, emergencies are unpredictable, but most patients are not crashing—there’s time to hydrate, eat, and reset.
•Practical applications:
oDrink water, eat proper nutrition, and rest before/during shifts.
oPrioritize morning routines (hydration, exercise, food) → sets the tone for the day.
oMeal prep to avoid cafeteria junk food and impulsive choices.
oCreate habits that are accessible (water bottles, packed meals).
•Mindset shift:
oCaring for yourself

Support the show

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Introduction

• My first experience with a cardiac arrest as a new EMT → exhilarating, confirmed calling to emergency medicine.
• Early struggles: dropped out of college, lacked discipline, but EMT training provided a direction and purpose.
• Spent years balancing work as EMT/paramedic with school → long path to becoming a PA.
• Lessons from emergency medicine shaped clinical skills and mindset.
• Concept of standards:
  • Standards = benchmarks, measurable expectations, non-negotiable habits.
  • Different from principles (general truths) → standards are concrete, either met or not.
  • Standards build consistency, resilience, and preparation.
• Personal struggles: binge eating, lack of discipline, repeated failures to meet daily goals.
• Turning point: completing 75 Hard program → developed discipline, consistency, higher personal standards.
• Standards spill over into clinical performance, family life, and personal growth.
• Emphasizes locus of control:
  • Focus on what you can control, not external factors.
  • Even in chaotic emergency medicine, there are controllable elements.
• Warns that neglected habits eventually become emergent problems (health, mindset, life).
• Family story: father’s heart attack → personal wake-up call about health and discipline.
• Core message: Raising standards in personal life and medicine leads to thriving, not just surviving.
• Purpose: help others raise their own standards without taking 16 years to learn the lessons.

Chapter 1: Do Not Seek to Diagnose

• Case study: elderly woman with shortness of breath and chest pain.
  • No pulmonary embolism, but fluid in lungs and around heart → problem found, but no definitive diagnosis yet.
  • Highlight: in the ED, the goal is to rule out life-threatening conditions, not always find the exact cause.
• Key principle: Diagnosis is often less important than identifying and stabilizing dangerous conditions.
• Emergency medicine limits:
  • Not every test or long-term treatment available.
  • Focus on acute, life-threatening issues; leave underlying cause to specialists.
• Patients often expect answers and certainty, but ED care is about safety and ruling out the worst cases.
• Overdiagnosis problems:
  • Incidental findings (lung nodules, brain aneurysms, ultrasound anomalies) → create stress, anxiety, or unnecessary proce

Support the show

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

Advice for new EKG techs:

Trust your knowledge and build your confidence over time, stay calm and take deep breaths when you start to get busy

Stay humble, ask for help

No one comes out of school knowing everything, you need to know your limits

Regardless of your role, don’t be afraid to advocate for the patient

Providers need to remember to project an approachable demeaner so that everyone has a level of comfort bringing things to their attention

It’s important to take your job seriously and do it to the best of your ability

Cheyenne talks about the stress of scribing

Sean talks about some frustrations he has with nursing putting in frequent EKG orders without the right indication 

We talk about some of the specialties within cardiology 

If you are looking into getting into medicine, look at EMT or EKG tech. They both give you a great insight into the greater medicine world

There are a lot of great jobs that introduce you to medicine before you take the risk of PA school or medical school

Sometimes the only way to really understand what you are getting into is to get into the field instead of reading about it or watching videos about it

Support the show

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition

We talk about stat vs routine EKG orders as well as metrics that they are always working to hit on time

When EKG’s are not done on time the source of the problem needs to be found, sometimes it is the providers’ fault for not realizing the EKG order had not been placed 

We talk about how we should communicate between provider and EKG tech and how much info we like to get as providers

I talk about how providers need to become good at task switching frequently and this includes signing EKG’s

We talk about the responsibility of the PA or NP to sign EKG’s (calling STEMI’s or deciding not a STEMI) and how this responsibility is currently in the hands of the physicians only

Sean talks about how important EKG’s can still fall through the cracks at times and people will still point the blame all the way back to the EKG tech

It’s important to make sure you do your job well and then realize some things are out of your hands

Cheyenne talks about an experience she had with an end-of-life patient she cared for

Even being just peripherally involved in a patient’s care can really affect you emotionally

Avoiding burnout:

Cheyenne likes to go to the gym or hang out at home with her dogs

Sean talks about how he avoids burnout doing a job that can sometimes be repetitive

Sean also talks about the importance of calmness in front of patients, even when an EKG might be alarming

Don’t sweat the small things, especially in the ED, everyone is under a lot of stress, and you can’t allow a small comment from a stressed-out coworker to get under your skin and make you spiral 

Sean talks about some methods to reassure patients despite not being able to diagnose their EKG 

We talk about the importance of stress management in the ED so that you can think clearly about the next patient

It is not your emergency, we must be the calm in the storm

Support the show

Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.

Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics

Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.

If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.

1st Phorm | The Foundation of High Performance Nutrition