SMFR EMS Podcast

New paramedics learn to work off a checklist, experienced ones learn when to think past it. In this episode, EMS Capt. Dusty King sits down with Medical Director Dr. Jonathan Apfelbaum and Paramedic FI Taylor Sweet to talk through the line between following protocol and using real clinical judgment. They dig into why protocols exist as a floor, not a ceiling, how regional consensus shapes updates across Denver Metro agencies, and walk through real calls where sticking to the checklist alone could've cost the patient.

In this episode of the SMFR EMS Podcast, host EMS Captain Dusty King sits down with Medical Director Dr. Jonathan Apfelbaum and Paramedics Spencer and Michael for a call review that starts as a routine diabetic emergency and turns into a genuine diagnostic curveball. The crew walks through their thought process on scene: a blood sugar that didn't match the presentation, a patient found tachycardic and profoundly hypertensive, and a rhythm that looked like textbook SVT until adenosine only bought them a brief look before it bounced right back. They dig into how a deeper history, including a recently discontinued beta blocker and a known diagnosis of Graves' disease, pointed them toward the real answer. Dr. Apfelbaum breaks down the pathophysiology of thyroid storm, from the TSH and free T4 labs to the in-hospital treatment sequence, and explains why the presentation so easily mimics other diagnoses. The conversation closes with a shared takeaway on avoiding anchoring bias and staying open-minded on the calls that don't fit neatly into a box. As the group puts it, working these calls together, bouncing ideas off a partner, is still the best care a patient can get.

In this episode of the SMFR EMS Podcast, host EMS Captain Dusty King sits down with Medical Director Dr. Jonathan Apfelbaum and Paramedic FI Nick Garcia for a candid conversation about culture, burnout, and what it actually takes to build a career that lasts 20-plus years in EMS. The group breaks down the difference between a "suck it up" culture and one built on debriefing, humility, and psychological safety, and how senior medics set the tone just by how they carry themselves. They walk through the warning signs of burnout, from dreading routine shifts and compassion fatigue to irritability, sleep problems, and pulling away from crews, and talk honestly about why unprocessed calls tend to resurface at the worst times. The conversation closes with practical, individual strategies for prevention and recovery: protecting sleep, physical fitness as career insurance, nutrition, and stretching into new roles or committees to avoid burnout from staying too narrow for too long. As Nick puts it, taking care of the provider is taking care of the patient.

In this episode of the South Metro EMS Podcast the crew talk though a midnight call for difficulty breathing at a Chatfield campsite quickly turned into a peri-arrest, leaving the crew to manage severe anaphylaxis with no clear trigger and no known allergy history. Paramedic Will Martinez walks through the call firsthand, Dr. Jonathan Apfelbaum breaks down Alpha-Gal Syndrome, a tick-borne condition that causes delayed, life-threatening reactions to red meat, and Lt. Mikel Hogestad shares what it's like to live with the diagnosis. The bottom line for providers: if it looks and smells like anaphylaxis, treat it that way.

In this episode of the South Metro EMS Podcast, the crew tackles something that doesn't get talked about enough, the gap between competence and confidence in paramedicine. Host EMS Captain Dusty King sits down with Medical Director Dr. Jonathan Apfelbaum and EMS Lt. Mikel Hogestad to explore what it actually looks like to move from knowing your protocols to trusting your judgment in the gray areas of real patient care. From navigating psych calls and reluctant patients to the hard lessons learned from calls that didn't go by the book, the conversation is honest, practical, and grounded in lived experience. Whether you're a brand new medic still finding your footing or a seasoned provider reflecting on your own journey, this episode is a reminder that growing from competent to confident is a process, not a moment, and that staying curious might just be your greatest clinical superpower.

In this episode of the SMFR EMS Podcast, we sit down with our Medical Director Jonathan Apfelbaum, and Associate Medical Director of EMS of Children's Hospital Dr. Claire Gahm to review pediatric emergencies, a patient population we don't run often but one that can catch you off guard when we do. The conversation covers clinical assessment, why pediatric presentations can be deceptively subtle, and how to build the pattern recognition that keeps your approach sharp. A solid refresher on staying confident and prepared when kids need us most.

In this episode, Dusty King and Medical Director Jonathan Apfelbaum break down adenosine in a practical, field-ready way. They review how the medication works at the AV node, when it is appropriate for narrow-complex regular tachycardia, and why Wolff-Parkinson-White (WPW) does not automatically rule it out. The conversation also highlights patient preparation, what to expect after administration, key contraindication concerns, and how to think through WPW with atrial fibrillation versus regular Supraventricular Tachycardia (SVT).

In this episode of the South Metro EMS Podcast, “Blood on Board,” EMS Lieutenant Dusty King sits down with EMS Battalion Chief Glenn Maxson (Med 1) and Medical Director Dr. Jonathan Apfelbaum to break down SMFR’s prehospital blood program from the street level to the system impact. Using a recent trauma call as the anchor, they discuss how crews identify “blood calls,” why a brief on-scene delay can be worth it to get blood started sooner, and how blood integrates seamlessly with high-performance trauma care, including airway management and RSI when needed. They also cover the why behind pairing blood with TXA and calcium, walk through the field setup (cooler, warmer, pump, pressure bag), and share early program outcomes showing improved survival and downstream resource benefits.

In this episode of Real Calls. Real Conversations. Real EMS., we take you into the cadaver lab at Link to Learn for a real-time look at managing difficult airways. We break down airway assessment, first-pass success, SALAD suction technique, bougie vs rigid stylet use, and how to adjust tools and approach based on patient anatomy, not provider comfort. The focus stays where it belongs: oxygenation, ventilation, and minimizing hypoxia while adapting in real time.

This episode features Medical Director Dr. Jonathan Apfelbaum and EMS Lieutenant Dusty King as they unpack when epi helps, when it adds nothing, and when it can actually work against your patient. Using real cases, they revisit alpha and beta receptor effects, walk through why there is no evidence-based role for epi in classic traumatic arrest, and contrast that with scenarios like neurogenic shock, tamponade, tension pneumothorax, and peri-RSI hypotension where carefully titrated push-dose epi can be appropriate. Along the way they review the MARCH algorithm, prehospital blood, TXA and calcium, ultrasound findings that clarify shock type, and those “medical vs trauma” MVCs where a cardiac event or PE causes the crash. The discussion blends fundamentals with nuance to give EMS providers practical tools to decide when the problem is volume, when it’s tone, and how to let physiology, not habit, drive the decision to reach for epi.