Practical EMS

I give my perspective on being an APP in the ED, be humble and teachable and strike an affect that allows the physicians to speak into your practice

When in doubt, consult the specialist

Julie talks about what makes her proud about her career

She is proud of the connections she made, that she treated her patients how she would have wanted to be treated

Remember to take that intentional time with patients to help reassure and connect with them

Julie talks about a the expectation she sets for patients with abdominal pain -  that we don’t find a clear answer most of the time and when we do it’s usually something emergent and surgical so sometimes no answer is good news

Set the right expectation for the ER visit early

She talks about how she reassures patients that may be embarrassed for coming in when they end up not having anything emergent going on

Julie highlights the need to eat and hydrate on shift

Julie talks about the next generation of providers and how she hopes they continue to keep their observation skills and clinical thinking skills intact considering technology advances and AI incorporation 

Julies advice to her younger self would be to not let people drag you down

A big thing we need to learn is to not let others poor behavior or flexing of their ego affect us personally, it speaks more about them than us

We need to learn to give constructive criticism without judging

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

Mindsets to avoid burnout – Julie humanizes the patient and understands that whatever difficult things we are dealing with are temporary and have gratitude

We must constantly recognize possible anchor bias and avoid cynicism to appropriately treat our patients

We talk about our interactions with EMS

Both Julie and I remember working in EMS and the value that EMS brings in their report because they often see a lot of things we don’t get from the history of the patient

Julies advice for the new APP/ER doc - don’t come to premature closure on a diagnosis, don’t be afraid to ask questions, pay off your loans over buying the biggest house and latest toys

We talk about the baseline level of stress we deal with 

We talk about technological changes over time and imaging improvements

She talks about the challenges that the Covid pandemic presented and the shortages of different things we have now encountered

Julie still finds meaning in finding the hard differential diagnosis and working towards positive patient interactions, the teamwork in the ER

I talk about the importance of creating an approachable affect so everyone feels free to voice concerns

Go look at the patient when the nurse is concerned 

Julie talks about the benefit for new EMT’s and paramedics to reach out and ask for feedback and follow up on their patients, often we don’t have time to pull them aside

EMS doesn’t have the best mechanisms in place for good feedback on every case like we do in the ER, where we see in real time how accurate our assessment may have been when the work up comes back

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

Started out her medical career as an EKG tech and in EMS as an EMT for one of the first ambulance companies in the area

She saw the disconnect between the provider that people wanted to become and who they became, and she didn’t want that to be true for herself

She became an attending in 1991 and now has close to 40 years in emergency medicine

She became a physician when it was predominantly a male field

Julie talks about some of the things that have changed over time

We need to have empathy for the people that come in for non-emergent complaints and realize that we have the honor in the ED to fill all the gaps in the wider medical system

We talk about the increase in transparency with patients and the access they now have to their lab work, imaging and chart and this helps us increase trust with patients

Julie talks about a paramedic partner she really admired and how well she treated patients, and how there wasn’t a lot of female role models for her in med school

I talk about how I also had partners that really improved the trajectory I was on as a new EMT

Seek first to understand is one of the 7 habits of highly effective people and this relates directly to taking care of patients

Julie talks about how it was to be a woman in medicine and how her voice got dismissed as well as the dynamics that are at play with patients

Julie talks about burnout and how labyrinth therapy helped her. How you need something that helps you look beyond yourself to have a moment of awe and gratitude

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

Brian talks about his experience being on the “other side” of the bedside with his wife’s cancer treatment

He really appreciated the extra time that the doctors spent with him and his wife to explain things – repetition is very helpful for your patients to really hear you

Brian talks about balancing fatherhood and being a husband with our emergency medicine schedules and the challenges of being in a physician couple 

You have to figure out family priorities and what works well in your situation

Date night is the most important investment you can make

We talk about how to transition from ER mode to husband and father mode

Brian talks about how finishing his notes helps to make his mind move on or answer some questions he may have to resolve a conflict he might be having

We talk about church attendance as Christians

Brian tells a powerful story where he was able to save and prolong a patient life so he could talk with his family

“Sometimes it’s more important to help someone die than to help them live”

We need to be intentional about remembering the big and the small good things that happen throughout our day

You never know when you might be the last person to interact with someone and may make the difference between them, deciding to give the ER another chance

Brian talks about advice to his younger self – don’t work as hard, take more time off

Prayer will get you to the right answer, if you call yourself Christian you should be displaying the Christian examples we are given

You shouldn’t have to leave your faith at home, it’s your best ally at work 

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 setting the right mindset, culture and tone as a leader of the department and especially in smaller facilities

You don’t have to be perfect, but you can avoid the little negative comments and criticisms

Being a good example goes a long way

As a Christian we are supposed to act like Christ would

We have a lot of metrics we have to worry about as clinicians but, as Christians, we need to worry about the metric of mercy

Understanding that we are not as far removed from the homeless, drug addicted patient as we might think

We have to remember that, as we care for the homeless and drug addicted person that no one else will care for, we are doing it for Jesus

Brian tells his students to spend as much time with the patient as they need, you don’t have to be the fastest provider right away

We have to be careful about bias getting passed on from triage and from EMS reports as well, sometimes the problem is more subtle and requires more time with the patient

How we word things when talking with patients makes a big difference

We talk about providing respect and dignity to those patients that die

Brian talks about some on-shift practices he uses to re-center himself on his purpose

We talk about the grey area in which we practice in the ED

I try to practice assuming good intent on others

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

Has been an attending physician since 2019

Brian volunteered when he was a teenager in the ER and the staff that got him involved really drew him toward emergency medicine in med school

Brian worked in the ED as an EMT as well

He talks about early mentors and the impact they have, including helping him get loans for medical school

We need to remember to be like that mentor that encouraged us when we were new and pay it forward to the next generation of students

You must have something that drives you in emergency medicine, it is a difficult specialty. At first the dopamine drive from the excitement can carry you a ways but it will fade over time

Brian talks about how faith led him to where he is now

We talk about the fulfillment of just having good conversations with patients and making sure they feel cared for and understood

Brian talks about recognizing burnout, it’s a “general sense of not being whole” like something has been taken from you

He talks about the golden handcuffs of being a physician

Brian talks about how he overcomes exhaustion and burnout

Cold plunging - forces you to be in the moment, control you heart rate and breathing

 Choosing hard things makes those hard things that are forced on you easier

Living in the moment is largely equated with happiness, the more you can do this the more you can be happy. Meditation and many other therapies are simply teaching you to keep your mind in the moment

A wandering mind is an unhappy mind

Prayer is another method for focusing your mind

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 the new EMT, paramedic, nurse, physician who is also a believer

Build your faith in the easier times so your faith doesn’t shake when times are hard

You have more reason than anyone on the planet who doesn’t believe to strive to do this job better every day, you are held to a higher standard

Adam still finds joy in emergency medicine, doing hard things, interacting with many different humans, seeking an answer, the intellectual stimulation

You must be able to embrace the hard stuff, embrace the suck

Adam talks about the priority he gives to family and being mentally present when he is physically present with his kids

He talks about the training that is required to make yourself mentally present outside of work and how to move on from a hard shift

“He told me to cast my cares to him because he cares for me”

Take care of yourself before you take care of others

In our line of work sometimes quality is better than quantity time

Adam gives the advice he would give to his younger self

He knows himself well enough to know he should say “Stay scared my friend,” because he can take that in stride and not panic. This job can be out to get you

You don’t know what you don’t know

Don’t step over the line between confidence and cockiness

Adam talks about some practices he has that allow him to move from ER physician mode to father, husband mode

Praise and worship music on the way home helps him

I try to remember to keep my eyes above the waves, like the story of Peter when he walks towards Jesus on the water

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

Faith and burnout

Adam talks about how he tends to spend his spare time reading the Bible, going to church, spending time in prayer and how this develops character and is better than pursuing time wasting activities or the easy dopamine dump that does not add to sustainability or self-improvement

We are designed to do hard things – mental or physical – including pursuing Jesus – this builds stamina, character and makes you better in your career

Choosing hard things makes the hard things that you don’t choose much easier to handle

Seeking hard, painful things can reset your own personal pain scale

We can find more reward and satisfaction in the suffering than the result, less satisfaction in being done

“Re-shift your mindset to find that the goal is the struggle and you are overcoming it”

Journey over destination

“The reward comes from striving, from the journey”

“That’s the example of Jesus”

We talk about the apostle Paul and his example

Social media skews our view of other humans; it polarizes us and makes us see the worst of humanity instead of seeing the good

There is some benefit to boredom 

All sacred texts talk about the need to meditate on these things, allow yourself to sit in silence and seek what you are trying to find

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

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