What if your judgment could mean the difference between life and death - or a lawsuit? In this razor-sharp episode of Physician Delegates, Dr. Adam Brenner, Dr. Martin Bennett, and Dr. Scott Ekin unravel the high-stakes world of patient refusal and shared decision-making in emergency medical services.

Imagine a scene where everything looks fine on the surface - normal vitals, a seemingly stable patient - but beneath those numbers lies a potential medical minefield. The Kitsap Delegates exposes the dangerous cognitive traps that can lead EMS providers to make fatal mistakes: group think, personality dynamics, and the seductive illusion of "it's probably nothing."

Drawing from years of frontline experience, Dr. Brenner, Dr Bennett, and Dr. Ekin break down the exact strategies that can save both patient lives and provider licenses. How do you create a structured pause that gives every team member a voice? Why does transporting a patient become the safest option when there's even a hint of disagreement? And what checklist could prevent you from becoming the next cautionary tale in emergency medicine?

Join us for an episode that goes beyond protocols and delves into the human elements of medical decision-making. Because in EMS, what you don't see can absolutely hurt you.

Postpartum Hemorrhage: When Every Second Counts

What if your worst nightmare call - imminent childbirth - turned into two critical patients and a race against time? In this intense episode, Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Ekin tackle one of EMS's most anxiety-producing scenarios: postpartum hemorrhage in the field.

Dr. Bennett walks us through a harrowing case that starts with a precipitous delivery in a bathroom - baby not breathing, mom pale and hypotensive, blood on the floor, and only minutes to figure out which patient needs you first. It's the ultimate "divide and conquer" moment that tests every provider's clinical judgment and composure.

The delegates break down the critical interventions that can turn a disaster into a save, tackle the system issues that complicate these calls, and share honest perspectives on why these cases still make even experienced providers sweat. They discuss the "Four T's" of postpartum hemorrhage, proper management techniques, and why having a checklist - even if it's Googled on scene - beats trying to remember everything in the moment.

Join us for an episode that embraces the discomfort, acknowledges that "something will go wrong," and arms you with the knowledge and confidence to handle one of EMS's most challenging calls. Because when mom and baby both need you, there's no room for hesitation.

What if everything you thought you knew about cardiac arrest was wrong? In this game-changing episode, Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Ekin blow up the traditional ACLS approach to PEA - revealing why "pulseless" doesn't always mean what we think it does.

Dr. Brenner takes us on a journey beyond the cookbook protocols, challenging the very definition of PEA and exposing a shocking truth: our fingers are terrible at detecting pulses. With studies showing we miss actual pulses nearly 50% of the time and hallucinate non-existent ones 35% of the time, it's clear we need better tools and smarter approaches.

The delegates explore the critical difference between true PEA (where the heart isn't moving at all) and pseudo-PEA (where patients are just profoundly hypotensive). They dive into cutting-edge strategies using end-tidal CO2 and pulse oximetry as objective measures of perfusion, discuss why high-dose pressors should be standard in PEA management, and explain why the mantra for these patients should be "PEA - don't stay and play."

From the promise of ultrasound in the field to understanding why CPR might actually harm some PEA patients, this episode delivers practical, modern approaches that go far beyond the outdated "epi-CPR-epi" cycle.

Join us for an episode that will fundamentally change how you think about and treat one of EMS's most challenging presentations.

Ever wonder why most addicts aren't actually trying to get high anymore? In this episode, Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Eakin dive deep into toxicology and addiction medicine - exploring the cutting-edge science behind why humans make the decisions they do and how new treatments are revolutionizing addiction care.

Fresh from an addiction medicine conference, Dr. Eakin shares groundbreaking insights about the anti-reward pathway, the neurochemistry of withdrawal, and why most people using substances are actually trying to avoid pain rather than chase pleasure. The delegates tackle the latest treatments for alcohol, tobacco, and opioid addiction, including revolutionary medications like acampersate, varenicline, and buprenorphine that are changing the game for EMS providers.

Dr. Bennett presents a fascinating case of diabetic ketoacidosis with normal blood sugar - a tricky presentation from the new SGLT inhibitor medications that's becoming increasingly common. The episode also features Dr. Brenner's dramatic case of a body stuffer who swallowed massive doses of fentanyl and methamphetamine, highlighting the critical differences between packers, stuffers, and pushers.

So sit back and join us for another educational episode designed to provide practical insights for EMS providers throughout Kitsap County, as we explore the complex world of toxicology and the promising future of addiction medicine.

Ever wonder how someone can survive when their kidneys completely fail? In this episode, Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Eakin dive deep into nephrology - moving from the "plumbing" we covered in our urology episode to the more complex "engineering and chemistry" of how kidneys actually work.

The delegates tackle kidney failure, renal replacement therapies including hemodialysis and peritoneal dialysis, the critical anatomy of AV fistulas and grafts, and kidney transplantation. They emphasize the pathophysiology behind uremia, electrolyte imbalances, and volume overload, while providing practical field guidance for managing these complex patients who rely on modern medical miracles to stay alive.

So sit back and join us for another educational episode designed to provide practical insights for EMS providers throughout Kitsap County, as we explore the fascinating and complex world of nephrology.

In this episode, Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Ekin, EMS Delegates for Kitsap County, WA, return for the third episode of the 2025 season. The delegates tackle the topic of urology, covering kidney stones, urinary retention, and various catheter types, with Dr. Ekin sharing both medical expertise and personal experiences. Their discussion emphasizes the pathophysiology, diagnostic considerations, and appropriate EMS interventions for these conditions.
 
The episode introduces a new feature called "Field Notes," where a Kitsap Paramedic presented a case involving a suspected pulmonary embolism that he managed with Dr. Brenner's medical direction. Dr. Bennett also provides a brief educational clarification regarding umbilical line placement techniques from the recent Medic Skills Lab. 

 So sit back and join us for another educational episode designed to provide practical insights for EMS providers throughout Kitsap County. 

In this episode, Dr. Martin Bennett, Dr. Scott Ekin, and Dr. Adam Brenner, EMS Delegates for Kitsap County, WA  welcome Dr. Alfred Wang as a guest expert to discuss the topic of dizziness in elderly patients. They share their enthusiasm for treating these patients and emphasize the importance of understanding the nuances of dizziness, including differentiating between various types and potential underlying causes. The discussion highlights the challenges EMS providers face in assessing dizziness and the critical need for thorough evaluations to identify serious conditions such as strokes. The episode aims to provide educational insights and practical tips for EMS providers.

Join the Kitsap County EMS Delegates, Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Ekin as they embrace the chill of winter and delve into the critical topic of hypothermia. In this episode, the team shares personal anecdotes from their snowy childhoods, while also discussing the medical intricacies of treating hypothermia in emergency situations. From the importance of accurate temperature readings to the challenges of resuscitation in cold environments, they provide valuable insights and practical tips for EMS professionals. Whether you're in the field or just interested in emergency medicine, this episode is filled with essential knowledge and engaging stories to keep you informed and entertained.

Welcome to the Delegates Podcast! Join Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Ekin, as they take a lighter approach this month, diving into the world of orthopedics. After exploring the complexities of neurology, they're ready to tackle lower extremity injuries just in time for football season. From knee dislocations to ligament tears, the team shares clinical vignettes, insights, and a few laughs along the way. Whether you're a medical professional or just curious about orthopedic injuries, this episode is packed with valuable information and entertaining anecdotes.

Continuing our journey into advanced neurology, the Kitsap County EMS Podcast presents the second installment of our in-depth series! Join Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Ekin, as they delve deeper into complex neurological disorders that EMS professionals may encounter in the field.

In this episode, our experts explore three significant neurological conditions in-depth, Multiple Sclerosis, Parkinson's Disease, and Dementia, from the perspective of what is going on in the brain and what it looks like with this disease. 

 Whether you're an EMS healthcare professional looking to enhance your clinical knowledge or simply curious about these neurological disorders, this episode provides invaluable insights to expand your understanding of the brain and nervous system.

Tune in to deepen your neurology knowledge and improve patient care with the Kitsap County EMS Podcast!