New panel with Adam and Sean. Emergency and IM medicine physicians 

There is a study from 2023 called Battles to Burnout. Studying the role of inter-physician conflict in burnout. Primarily the conflict between emergency physicians and internal medicine physicians. A better relationship leads to less burnout

Sean moved from primary care to hospitalist medicine when COVID was at its peak

Adam, EM physician, returns to the show

Sean enjoys solving problems and that is what drew him to IM and hospitalist medicine, he did a 3-year residency

He brings up an important distinction of our mindsets in patient care. In the ED we are looking more to find the problem, but he looks to solve the problem in the hospital

In some ways, in the ED, we are a glorified triage. But more importantly, we are expected to be the second best in every specialty - the second best cardiologist, second best GI etc

We do still do a lot of problem solving in the ED as well, but we usually do have the skill of a lower cognitive switching cost, we can move between tasks quickly

We to have to take efficiency into consideration

Sean talks about the superpower of IM being storytelling – one of his struggles is finding the best story to explain to everyone involved what is going on with the patient – sometimes the ED does not give the best story

We need to help start the right story to help the IM physician on the back end to set them up for success

Our limitations using a text platform to communicate does make it hard to read the intent behind questions

With admission requests, Sean likes to hear what we think is going on. Not just a bunch of data points but rather the start of that story

Sean also likes to hear the chief complaint first, similar to what I like from our EMS crews

A 5- or 6-line paragraph max is sufficient, they start to worry when the paragraph gets longer that we either don’t know what’s going on or so much is going on its going to be a difficult case

As APP’s we don’t get a ton of training in admission request story telling so it’s an art we have to develop

An admission request is a great time to slow down and really think about all the details

Being an ER APP can be a difficult position when working as a team with a physician. We tend to adapt to the physician we are working with. We share tasks and sometimes don’t get all the same details on a given patient

Patient hand-offs are a big source of information loss and errors. We can tend to turn patient st

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

A difficult aspect of the job is the poor understanding of the public of what we do in EMS, and the poor understanding that our non-EMS friends and family have of what we do

Those of us in EMS can understand each other better, we have seen the same tragedy and struggled with the same difficulties that are so hard to articulate

What does retirement look like from a career paramedic in EMS?

Casey struggles with this, it’s hard to think about not caring for patients anymore. The closer he gets to retirement, the more it looks a little less clear what that looks like exactly

Eddie isn’t planning retirement soon so he can help provide for his kids. He does have retirement investments and fire benefits

Advice for newbies in EMS:

If you are seeing warning signs of burnout, get counseling immediately. Don’t write it off or try to ignore it as normal

Eddie would not have tried to fight the warning signs of PTSD, he would have sought help much sooner

He did struggle with suicidal thoughts for a period of time – counseling was the solution. Sleep deprivation was a major factor in these thoughts for him

He had a breaking point where he felt ready to end his life – a counselor called him back at 2am and got him in quickly to talk and this helped him significantly. And he now feels the best he has mentally – it doesn’t control him anymore

Casey talks about how few make paramedicine a career, it’s a tough job and it has changed over his career, he recommends finding the fun. Learn new things. Self-reflection goes a long way

Recognize when you need to switch to a different place, organization or company as a paramedic

Casey: “I feel bad, because I don’t feel bad”

We all feel different and respond differently to the things we see - you don’t choose the things that affect you

Don’t be afraid to say something to your coworkers if you see something wrong, even though it’s hard and confrontational – this helped me significantly when a partner called me out early in my EMT career

We’ve lost people in EMS through the years, this is devastating. We share life with our partners and get to know them really well

When Eddie was feeling similar thoughts of suicide to our coworkers that committed suicide, it was a huge eye opener for him to see the grief of their loss

Bad calls can haunt you; we have all seen it in others and ourselves

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

I tell those EMT’s that want to go to PA school or further education to just skip paramedic school. Go to paramedic school if you want to be a paramedic

“I’m not doing it for the pay, I’m doing it because I love it.”

Being a paramedic puts you in a unique position to save someone’s life in the span of 5 minutes

Eddie took calls personally. He gave every call his everything

Sometimes the patients survive despite all the odds being against them and some die despite all the odds being in their favor

We have to remember to respect the patients that may not have earned it because it speaks more about who we are than who they are

We will always have patients that treat us poorly, but it is more about rising above and detaching

We have the privilege of taking care of people on their worst days

Eddie talks about how EMS caused him to mature quickly 

You will always have to deal with Karens in emergency medicine, you must rise above their bad behavior

Patients deserve our professionalism and respect even when they may not have earned it

Eddie talks about the difference between being in the field as a paramedic and in the ED

Eddie talks about how important it is to treat your patient as a human and not be a robot but be a human yourself

We need to build rapport and trust with our patient in order for them to accept our plan of care

Often the concern is different than the chief complaint

We talk about how certain tasks become second nature and allow you to converse with patients simultaneously 

Humor can really help improve your patients’ care if you can read the room accurately

You don’t have to be an extrovert to be successful in EMS

We talk about how, working in emergency medicine, it can really take all the social energy you have

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 the immense responsibility and stress of being a paramedic and the stress difference I’ve noticed moving to ER PA

Casey talks about RSI and how it still causes his palms to sweat

We should have a healthy respect for high level skills

As paramedics we can tend to focus too much on a complicated task and neglect the overall picture of what is happening with the patient, a good partner can really help avoid this

It can be really challenging with a partner that is not watching your back adequately and needs to be micromanaged 

A good EMT anticipates the paramedics’ needs

Good BLS will lead to good ALS care

You have to trust yourself as a paramedic before you can trust your partner

The further you progress in medicine; you tend to stop advertising that you are in medicine

Sometimes the mistakes or the hard calls are easier to recall than the good calls or the victories

Casey talks about a rough pediatric call when he was a new paramedic

Fortunately, the really hard calls are few and far between

Eddie feels like the bad calls are how EMS has damaged him. He struggles to remember the good calls, or the calls where he felt like he did a perfect job

He lives with regret where he feels like he could have done better as well as the tragic calls and feels like this gets worse with time

Sometimes ignoring the trauma for years on end really ends up affecting you when you are older

The jokes can be a cover for how you really feel

But as a paramedic you have to detach and be above the fray, getting stuck in the same emotions as everyone else will not allow you to effectively do your job

Eddie talks about an incredibly tragic case he ran that always haunts him

Once you start getting into the mentality of BSI scene safe, you tend to start practicing that in all areas of life. You get used to always making sure you are safe

We talk about private ambulance and the difference between retirement and disability benefits from fire service 

It’s really hard to switch from being a paramedic to another career after a certain period of time

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

Best online EKG course you can finish in less than 4 hours:
Practical EKG Interpretation - Practical EMS

4 Category 1 CME credits - Fundamentals through advanced interpretation

Welcome our new panel Eddie and Casey, two very experienced paramedics

27 and 48 years in the field

Casey talks about AI potential in the field and a study he was involved in. Will AI help us or improve patient care? Will humans be needed at all?

Can AI replicate your gestalt?
 Is our gestalt worth trusting normally anyway?

Why do we see so many paramedics using the career as a steppingstone to other careers, I certainly viewed it this way when I was a paramedic

Eddie talks about starting in EMS because he knew it was the right thing to do. It feels like that is getting lost due to the softening of medicine. Becoming a paramedic was harder, the barrier to entry was harder. Have we lost our pride in this being a career rather than a job?

I remember having a lot of accountability from my peers when I was a new paramedic. I had some level of fear that I would be criticized by other crews and physicians if I didn’t perform well

Is part of the difference a lack of feedback from peers and physicians?

Has EMS gotten too soft?

Casey wonders if we are not putting enough emphasis on accountability to our peers because of fear of offending people

We talk about how much fear there used to be of the medical directors. But the environment has changed positively in a lot of ways as we learn and grow from mistakes more than getting punished for them

We talk about being a new EMT, being cocky

Where are the people that want to stay as a paramedic as a career? Not everyone is cut out to make it a long-term career

Some people get stuck in EMS, Eddie and Casey were more intentional about choosing it as their life

For some people it’s a job, for some it’s a life

How we present ourselves to the patient is important, we have limited time to make an impression and gain their trust

EMS has had periods where different services have just needed “butts in seats” and maybe this led to decreased expectations

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

Whatever your beliefs regarding God or lack of a God as you work in emergency medicine, I hope this episode will uplift and encourage you

Laurie likes to reflect on the one patient she was there to help during the day. Or the one patient she was there to interact with

It is important to reflect on your highs, your lows and even things that made you laugh

Where is that line of caring for people and balancing your own family and priorities?

Jesus said the poor you will have with you always. You will never be able to fix every problem. We can’t take on a God complex. We have to check on ourselves to know when we are giving too much of ourselves

Daniel raises a point in his book, that the fruits of the Spirit are produced by you going through difficult situations with difficult people

Overcoming difficult things can make us better if we allow it to and we can be a light to those around us

Every day is not “I am blessed and highly favored”, there are some days where you feel bright and full and others where everything is difficult

Jesus knows that the pain of getting well is sometimes greater than the pain of staying stuck

Is emergency medicine your purpose?

Eric talks about the blessing it is to directly impact another person, but it is not his life’s mission. His identity is not an ER physician, it is a child of God

Laurie overall agrees but she stresses that she is called to be an ER PA. It’s the expression of the skills God has given her

I think I am somewhere in between the two of them, I definitely feel called to work in the ED but don’t want it to be my whole identity either

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

Whatever your beliefs regarding God or lack of a God as you work in emergency medicine, I hope this episode will uplift and encourage you

Daniel talks about how the most anxious person in the room gets the most attention, but we should strive to be the non-anxious presence in the room. The non-anxious presence rebukes and resets the system

Daniel talks about how the people of God should strive to be like Jesus on the boat when he slept during the storm and say “Peace, be still” to the chaos

Remember how we treat people reflects who we are

Emotional whiplash occurs as a pastor or as an emergency medical professional

Daniel has gone from dedicating a newborn baby to helping a patient pass peacefully

Habits to hit the reset button:
 I like to walk to patient rooms rather than speed walking. This allows me to take a deep breath, practice mindfulness and reset myself to approach the encounter well

Slow is smooth, smooth is fast

Try to smile 

Engage with the patients that fill your cup and appreciate your care, talk with that staff member that is kind and happy

Daniel talks about breath prayers: “Come Lord Jesus”, “help me Lord,” “Lord I need you here” “Come Holy Spirit”

Daniel talks about how we help with anxiety. When he sees people in his office at church or in the hospital, they are often anxious just like our patients

He says one way he combats anxiety is asking the person’s full name. What does your middle name mean? Is that a family name? He quickly digs into the details about a person’s life, and this can cause the anxiety to diminish. It shows interest in the person

The greatest sound to a person is the sound of their own name

Often the patients chief concern is not the same as their chief complaint 

In order to give to others, you have to have a full cup first, then what overflows is what you have available for others

How do we unburden ourselves of the things we take on at work?

Eric can compartmentalize

Laurie talks with her spouse to digest the things that happen during the day

Personally, sometimes I want to talk about my day and other times I don’t want to talk at all about my day

Daniel talks about how to avoid “taking home the hitchhikers.” We often see sad stories in our line of work and we can’t allow this to negatively impact our close relationships

Daniel jumps on his trampoline, screams into a pillow or goes to a steam room and gives the burdens over to the Lord. He also doesn’t shield his life from

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

Whatever your beliefs regarding God or lack of a God as you work in emergency medicine, I hope this episode will uplift and encourage you

New panel! Welcome Pastor Daniel Grothe, ER Physician Eric and ER PA Laurie

Daniel talks about the life of a pastor, which isn’t exactly as we all might assume. He talks about being a brand new, young pastor and how he responded to the home after the suicide of a 16-year-old boy

One of his first calls as the pastor on-call was the death of a 7-month-old boy

His experience, being a young pastor, not fully trained in how to handle the most difficult of scenarios, but jumping in anyway is not dissimilar to being a new EMT or paramedic

He’s not worrying about the medicine aspects like we do but his frequency of dealing with death and dying is very similar to my experience

He talks about how we come into peoples lives where they are and try to bring healing to them, and this can be costly for us as well

The ratios of doing the big things like weddings and sermons to the dealing with death and dying is not what you might expect as a pastor, a large portion of time is spent walking through the valley of the shadow of death with others

Laurie talks about an ER she used to work at and the amount of trauma they saw that was often not survivable

I recount the cardiac arrest of a 4-year-old I ran years ago and how this caused me to wrestle with God

Daniel talks about the times he has wrestled with God. Including the time New Life Church had an active shooter on campus that killed two young girls

Christians often want to see things like the stories in the book of Acts, miracles. But Acts takes place in 5 cities over 40 years. So, Daniel says, stick around a place for 40 years and you will see all of those things happen while also attending funerals and seeing death

Why do bad things happen to good people?

Daniel looks at what we do as working on this side of eternity to participate with God to be God’s representative to those that are suffering

We all get into the field to help others, but this can get lost in the tasks we have to do during the day

We have to remember that our actions and how we treat patients, regardless of complaint can demonstrate God’s love

Burnout comradery is a problem when we all get in a feedback cycle of complaining about the day and the patients.  It might feel good in the moment, but it leads to burnout

“That smelly homeless person that just puked on my shoes is made in the image of God”

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

Kevin Hazzard 

Author of A Thousand Naked Strangers and American Sirens (you can find these on Amazon or wherever books are sold). You can find Kevin Hazzard at KevinHazzard.com

Kevin talks about the story Jesus told of the good Samaritan as really the first example of EMS. Jesus tells this story in response to a lawyer asking him how to obtain eternal life. A man was attacked on the road and left for dead. Many people that society perceives as “good” pass by this man but a Samaritan took the time to stop, dress his wounds and takes him somewhere to put a roof over his head and allow him to heal

Kevin talks about how society has never put sustained efforts into saving people outside of the hospital until the 60’s

The white paper published in the 60’s indicated that you were more likely to survive a gunshot wound in the Vietnam war than in the streets of the United States because you would have someone trained in first aid at your side

There was significant emphasis on intubation for early paramedics. This was a skill very important to the early physicians because they knew the life saving potential 

We talk about the evolution of intubation and how emphasis seems to be changing and the important of still training on this skill because it can be very difficult and high stress

I think it is important to increase training rather than remove a skill set from paramedics

We talk about video options for intubation and the potential future of training

The first paramedics in American Sirens were black men that served their community called “The Hill”

Pittsburgh in the 1960’s was a very difficult city for African Americans. Jobs were not available. They were told they had no value. Then Freedom House ambulance gave them a purpose designed by the father of CPR himself, Peter Safar

Going from not worthy of anything to being trusted with paramedicine at the highest level for your own neighbors, your own community

The first call they run is in the aftermath of Dr. Martin Luther King Jr’s assassination

Peter Safar, the father of CPR and an anesthesiologist, designed the early ambulances in a configuration that is still used today, a captains chair because he wanted good access to the airway

Their first medical director, Nancy Caroline, wrote the foundational EMT education text book

The great tragedy is no one can really tell you about Freedom House ambulance until now, the story was intentionally buried and f

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

Kevin Hazzard 

Author of A Thousand Naked Strangers and American Sirens (you can find these on Amazon or wherever books are sold). You can find Kevin Hazzard at KevinHazzard.com

What does Kevin miss about EMS?

He misses the partnerships and the chaos you went through together.

The memories he has are both good and bad from his time in EMS, the failures and the mistakes but also the victories

We get into Kevin’s newest book American Sirens

We talk about the difficulties in controlling and bringing order to a chaotic scene and how this is a skill that has to be developed over time

Kevin tells a story about a call with a panic attack and how this may be normal for us but for the patient experiencing the symptoms, it may be a real unique and scary scenario

Kevin’s “large” partner would take control of the scene that was out of control by pushing the biggest dude up against a wall and then everyone else would back down

Even without size on your side you have to present external confidence on scenes

A situation that, by definition, is out of control, must be controlled

Even those scenes that are not out of control, you still need to convince grandpa that you will take great care of grandma and you understand how important she is

We talk about the story of John in American Sirens and how EMS gave him purpose and how EMS gave us purpose as well

John was a black man that grew up in a segregated city, extreme poverty, his mother died of alcoholism and his father ultimately had to give him up to an orphanage. But John didn’t give up and he saw the respect and dignity that was given the earliest paramedics at Freedom House ambulance, even as black men, and worked his way into practicing paramedicine at the highest level

This was a time that, in the city of Pittsburgh, if you had a medical emergency, it was handled by two cops

Kevin does a great job of articulating Johns full circle in the book. He goes from orderly, the lowest of the lows in the hospital, to practicing paramedicine at the highest level, intubation, and bringing in critical patients into the same hospital ED

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