The Delegate Series

What if the most important skill in your career has nothing to do with airways, drips, or protocols? In this episode, Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Ekin come back to what they call the most important topic in the Delegate Series: clinician wellness, burnout, and resilience.

The episode opens with Dr. Ekin’s graduation address to this year’s Kitsap Fire Academy class, built around three ideas. You are a hero, but not for the reasons you think. This is a marathon, not a sprint. And you won’t do this alone. He argues that the heroism isn’t the dramatic rescue. It’s the promise that someone will come, made good at 3 a.m. on the ordinary calls. He’s just as direct about the cost: the need is endless, your capacity is not, and self-care is not optional.

The delegates then unpack the address with every provider in mind, from new graduates to seasoned medics who stopped getting a buzz from the “big calls” a long time ago. They lay out a practical game plan for the minutes after a hard call. That means box breathing to calm the stress response, taking care of your body first, saying “that sucked” out loud, and taking a “virtual smoke break.” They talk about making a clean, deliberate break before you go back in service. They also cover a 2024 French study in Prehospital Emergency Care in which a structured program measurably reduced paramedic burnout. And they draw a line between guilt (“I made a mistake”) and shame (“I’m broken”), and explain why shame should set off alarm bells.

Join us for an episode about thinking of bad outcomes as system lessons, not personal failures. It’s about giving yourself the grace you’d give your partner, keeping a record of your wins, and watching each other’s backs. This career should fill your cup, not just empty it.

What if the most important thing about the 2025 ACLS guidelines isn't what changed — but what the science is already outpacing? In this episode, Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Ekin walk through the latest American Heart Association updates and hold them up against what the evidence is actually telling us.

Dr. Ekin breaks down the official changes — from the atropine dose that quietly doubled to the oxygen saturation target that finally got specific — while the delegates weigh in on where AHA is playing it safe. Double sequential defibrillation showed a 30% survival-to-discharge rate in its landmark trial, but the guidelines won't commit. Calcium for hyperkalemia? Three delegates and decades of clinical experience respectfully disagree with "insufficient evidence."

Along the way, the conversation lands on what might matter most: the growing recognition that BLS owns the cardiac arrest. Early CPR and rapid defibrillation still move the survival needle more than any drug or advanced airway — and the delegates make the case that an i-gel and uninterrupted compressions beat a heroic intubation attempt every time. Dr. Brenner previews emerging research on CPR hand positioning that could change what we teach about compressions, and the group tackles the post-ROSC tightrope of blood pressure targets, ventilation goals, and why a second hypotensive episode can undo everything you just fought for.

Join the Kitsap physician delegates for an episode that separates what's settled from what's evolving — and reminds us that in ACLS, the most dangerous thing isn't a wrong answer. It's an old one you never thought to question.

 What if the most dangerous call you run today isn't the cardiac arrest or the multi-vehicle pileup — but the 82-year-old who "just fell"? In this eye-opening episode, Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Ekin tackle the patient population that makes up nearly half of all EMS contacts — and the one most likely to hide life-threatening pathology behind seemingly normal vital signs. 

Dr. Bennett walks us through a landmark review from the Journal of Emergency Medicine, exposing the clinical landmines lurking in every geriatric call: the shock that masquerades as a normal blood pressure, the cervical spine fracture hiding behind a simple "lift assist," and the massive subdural that presents with a perfect GCS of 15. With nearly 70 million Americans now over 65, these aren't edge cases — they're your bread and butter. 

The delegates break down the art and science of slowing down in a profession built on speed — why shutting your mouth for two minutes gets you better information than rapid-fire questioning ever will, how a shock index below one can still spell disaster in an elderly patient, and why the single most high-yield question you can ask might just be, "Did your doctor change your medicines?" From the deceptive normalcy of geriatric vital signs to the hidden dangers of the "routine" lift assist, this episode arms you with the clinical street smarts that separate good providers from great ones. 

Join us for an episode that proves the unsexy calls are where real clinicians are made. Because in geriatric EMS, what looks like nothing can kill — and the provider who slows down is the one who catches it.  

What if the most routine interventions in emergency medicine weren’t as simple as we thought? In this episode of Physician Delegates, Dr. Martin Bennett, Dr. Adam Brenner, and Dr. Scott Ekin take a rapid-fire tour through some of the most important emergency medicine research of 2025 — and what it actually means for the crews working in the field.

From the subtle science behind something as basic as oxygen, to the evolving strategies for pre-oxygenation before intubation, the delegates unpack new evidence that could change how EMS providers manage the sickest patients. They tackle the long-standing debate between ketamine and etomidate for rapid sequence intubation, explore surprising new research on ketamine’s role in stopping refractory seizures, and examine how ultrasound may uncover hidden shockable rhythms during cardiac arrest.

Along the way, they also highlight practical updates every EMS provider should know — from choking treatment in infants, to safer oxygen targets, to the quiet return of an old emergency medicine favorite: Droperidol.

Join the Kitsap physician delegates for a fast-moving conversation that connects cutting-edge research to real-world EMS practice. Because sometimes the biggest improvements in patient care come from re-examining the things we thought we already understood,

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.