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EMS education has come a long way, but are we actually preparing clinicians to think critically, make decisions, and perform under pressure? In this episode of the FOAMfrat Podcast, Tyler sits down with Dr. Harrison Brookman and Mike Carunchio, host of The World's Okayest Paramedic, for a candid discussion about the current state of EMS education and where it needs to go. From the limitations of traditional classroom instruction to the value of realistic simulation, the conversation explores what it really takes to develop competent clinicians. The group also discusses the role of EMS conferences, learning from specialists outside emergency medicine, and the growing influence of social media educators. Topics include: How initial EMT and paramedic education has evolved Teaching critical thinking instead of memorizing algorithms Why simulation should prepare students for situations where everything goes wrong Building clinical confidence through experience and decision-making The value and limitations of EMS conferences What other medical specialties can teach prehospital clinicians The difference between education and entertainment on social media Why curiosity may be the most important quality in an EMS educator Whether you're an EMT, paramedic, instructor, or medical director, this episode challenges some familiar assumptions about how we teach, learn, and maintain clinical competence. Check out Mike Carunchio's podcast, The World's Okayest Paramedic. Subscribe to FOAMfrat for more conversations on prehospital medicine, critical care, and EMS education. #FOAMfrat #EMSEducation #Paramedic #EMT #FOAMed #CriticalCare #MedicalEducation

What if the way you pack your gear could actually make you better at resuscitation? In this episode of the FOAMfrat Podcast, Tyler sits down with Adam LaChapelle from The Resus Tailor to talk about resuscitation architecture: designing bags, equipment, and workflows around how clinicians perform under pressure. They break down the small details that can have a big impact on scene: where equipment lives, how kits should be organized, why standardization matters, how to reduce unnecessary cognitive load, and how to build airway and medication setups that follow the natural sequence of a procedure. The conversation gets into BVM and suction placement, RSI kits, medication organization, pediatric equipment, cric kits, cardiac arrest loadouts, and even the debate over where the zippers should be when you close your bag. The goal isn't to buy a fancy new bag. It's to ask a better question: *Does the way we organize our equipment make it easier or harder to take care of a critically ill patient?* Adam also gives us a look at the DECENT airway simulator and discusses how better training equipment can help clinicians develop more realistic airway skills. Whether you're designing an entire EMS system or just reorganizing the jump bag on your truck, this episode will probably make you look at your equipment a little differently.

The Future of Airway Quality Improvement: Learning from Every Intubation In this episode of the FOAMfrat Podcast, Dr. Harrison Brookeman sits down with John Winstead, Captain of the EMS Specialist Program at Fairfax County Fire and Rescue, to discuss how video laryngoscopy recordings are changing the way we evaluate, teach, and improve airway management. From building a sustainable airway recording program to creating a culture of objective feedback, they share practical lessons learned from reviewing hundreds of real-world intubations. The conversation explores first-pass success, the importance of suction and preparation, team-based airway management, and how video review can transform both individual performance and system-wide practice. As airway procedures become increasingly rare but remain critically important, the question is no longer "Did we get the tube?" It is "How can we get better every single time?" Tune in for a forward-looking discussion on the future of airway education, quality improvement, and the role technology may play in making prehospital airway management safer and more effective.

In this episode, flight paramedic Nicholas Henchal and EMS physician Dr. Harrison Brookeman break down salicylate toxicity from the ground up. What started as a casual conversation at the crew table turns into a deep dive into one of the most misunderstood overdoses in EMS and critical care. They walk through the full spectrum of aspirin toxicity, from subtle prehospital clues to advanced hospital management. You'll hear how patients can appear relatively stable early on, why respiratory alkalosis precedes metabolic acidosis, and how the situation can spiral once the electron transport chain is disrupted. The conversation also delves into real-world decision-making: when to suspect it, when not to intubate, how to manage ventilation if you have to, and why treatments like bicarbonate, glucose, and even dialysis play a critical role. There's also a strong discussion of the dangers of missing this diagnosis and how quickly things can go downhill if the underlying physiology isn't understood. Link to interactive Anion Gap Tool: https://claude.ai/artifacts/latest/d3b744cf-5a1b-4bb7-88bc-4f74fd97ec16 FOAMfrat.com

What does sepsis management look like for EMS? Tyler and Kevin Collopy break down the current state of sepsis care, including EMS recognition, hospital sepsis bundles, fluid strategies, vasopressor use, lactate trends, and the debate around prehospital antibiotics. The conversation focuses on practical decision-making and why identifying septic shock early can change outcomes long before the patient reaches the hospital.

"GCS less than 8, intubate." We've all heard it. Many of us were taught it. In this episode of the FOAMfrat Podcast, Tyler and FOAMfrat educator Nicole Hooser examine one of the most repeated airway phrases in EMS and why it may be doing more harm than good. From the origins of the "less than 8" mindset in GCS to the real-world complexity of airway decision-making, this conversation examines what actually matters when deciding whether to take a patient's airway. They discuss: • Why a GCS of 8 is not a magic number • The math behind GCS scoring combinations and why 8 carries so much variability • Airway protection versus airway reflexes • Resuscitation before intubation • The momentum problem once an RSI has been initiated • When hesitation is appropriate • When decisive action is necessary • Flight-specific pressures and transport considerations • Sedation versus full RSI • Reversible causes of altered mental status you cannot miss Nicole shares real-world flight cases, including moments of disagreement with partners and the professional growth that follows those cases.  The episode also explores how experience, bias, fear, and pattern recognition shape airway decisions. If you've ever wondered whether you truly needed to intubate a patient, this episode challenges reflexive thinking and reinforces a more deliberate approach. Guest: Nicole Hooser Listen in and weigh in on the discussion.

In this episode of the FOAMfrat Podcast, we sit down with Joe Hylton, one of the go-to ventilator educators in critical care transport, to break down APRV in a way that actually makes sense. We move beyond surface level explanations and get into how APRV really works, why it is so effective for ARDS and severe hypoxemia, and how volumetric capnography can give you real-time physiologic feedback when titrating mean airway pressure and PEEP. This is not a "set it and forget it" APRV discussion. We dig into the mechanics, the physiology, and the bedside decision making that matters in transport and critical care environments. Topics covered in this episode: • How APRV differs from conventional pressure control ventilation • Why mean airway pressure is the real driver of recruitment • Using flow curves and time constants instead of guesswork • Volumetric CO₂ vs end-tidal CO₂ and why the difference matters • Identifying optimal recruitment and overdistension in real time • How VĊO₂ trends can guide PEEP and pressure adjustments • APRV pitfalls, misconceptions, and when paralysis may still make sense • Practical APRV setup on Hamilton ventilators for transport teams If APRV has ever felt like ventilator voodoo, this episode pulls the curtain back and ties the mechanical settings to what is actually happening at the alveolar and capillary level. Joe brings deep experience from working with Hamilton Medical systems, and the discussion is framed through real-world transport and ICU decision making, including insights relevant to teams like Life Link III and other critical care programs. This episode is ideal for: • Flight paramedics and critical care transport clinicians • ICU nurses and respiratory therapists • Medical directors and educators • Anyone who wants to understand APRV beyond memorized settings 🎧 Listen, learn, and rethink how you approach lung recruitment. Subscribe for more high-yield critical care and EMS education from FOAMfrat.

In this episode of the FOAMfrat Podcast, Dr. Harrison Brookeman joins the discussion to examine methemoglobinemia and the emerging prehospital threat of sodium nitrite ingestion. Often viewed as a rare toxicology concept, this condition is appearing more frequently and can progress rapidly with devastating consequences if it is not recognized early. The episode focuses on what matters most to EMS clinicians in the field: the physiology of methemoglobinemia, why these patients appear profoundly hypoxic despite adequate ventilation, and the classic clue: a pulse oximetry reading that remains fixed around 85 percent regardless of oxygen delivery. The conversation also addresses iatrogenic causes such as benzocaine exposure, expected mental status changes, and why oxygen alone does not correct the problem. Emphasis is placed on prehospital decision-making, including early involvement with poison control, transport destination considerations, and the importance of ensuring these patients are taken to the right facility the first time. This episode is intended to sharpen recognition, improve pattern awareness, and prepare providers for a call that does not follow typical respiratory failure patterns.

A little over a year ago, I made a short reel discussing ventilating a patient in a severe metabolic acidosis. In the video, I mentioned that minimal to no PEEP might be appropriate. Not because the patient doesn't need PEEP, but because the shortened cycle time at higher respiratory rates can unintentionally generate dynamic PEEP on its own. But what if it was intentional? What if the presence of a wider pressure when the ventilator switches into exhalation would cause the air to exit more rapidly? In this podcast, I discuss my thought process with respiratory therapist extraordinare, Melody Bishop @melodybishop_rt. She helps surface some definitions and distinctions to terms like air-trapping, Set PEEP, & auto-PEEP while we discuss ventilation strategies in metabolic acidosis. The blog below was what I had sent her before the podcast to get all my thoughts & illustrations down in writing. As always, please follow your local guidelines, and I hope you enjoy listening to the conversation.

Pelvic binders have long been considered a standard intervention in the management of suspected pelvic fractures in the prehospital setting. However, recent guidance from the National Association of EMS Physicians (NAEMSP) challenges some of the long-standing assumptions surrounding their use. In a recent FOAMfrat podcast episode, I spoke with Dr. John Lyng, editor-in-chief of the NAEMSP Trauma Compendium, to explore the evidence and rationale behind their newly released position statement on pelvic fracture management.

In this episode, Tyler sits down with Hanna Thompson to discuss a critical yet often overlooked topic in EMS—eating disorders. Drawing from personal experience and clinical insight, they explore how these conditions present both medically and behaviorally, especially in prehospital and interfacility transport settings. They break down the subtle physical signs that EMS providers can look for—such as Russell's sign, lanugo, unexplained bradycardia, and electrolyte disturbances—and emphasize the importance of sensitive history taking. The conversation also dives into the dangers of refeeding syndrome, slow correction strategies, fluid choice, and the clinical significance of thiamine, magnesium, and phosphate replacement. What You'll Learn: How eating disorders can manifest in EMS calls Why you may be treating the consequences, not the disorder itself Red flags like bradycardia, lanugo, and Russell's sign How to handle refeeding syndrome safely Why dextrose, fluids, and electrolyte replacement should be approached cautiously The connection between electrolyte shifts and seizures or arrhythmias Key Takeaway: Patients with eating disorders are medically and psychologically fragile. In EMS, we often encounter them through the effects of the disorder—not the diagnosis itself. Recognizing subtle clues and avoiding aggressive interventions could save a life. Resources Mentioned: Hannah's blog on EMS considerations in eating disorders Data on post-COVID spikes in eating disorder incidence Guidelines for electrolyte correction and refeeding syndrome Disclaimer: This podcast is for educational purposes only and not a substitute for clinical protocols or medical direction. Always consult your agency's guidelines and medical control.

In this episode, Tyler Christifulli sits down with cardiac perfusionist Brian Cress to dig into the physiology of coronary perfusion, the mechanics of the intra-aortic balloon pump (IABP), and the clinical finesse of diastolic augmentation. Whether you're just starting to encounter balloon pumps or want to sharpen your transport strategy, this discussion is packed with visual metaphors, waveform analysis, and real-world pearls.

In this conversation, Dr. Peter Weimersheimer discusses various techniques and tips for performing cardiac ultrasound in emergency medicine. He emphasizes the importance of understanding probe movements such as sliding, fanning, and rocking to optimize cardiac views. The discussion also covers troubleshooting common challenges in cardiac imaging, the critical role of gel in obtaining clear images, and the transition between different cardiac views. Dr. Weimersheimer emphasizes the importance of identifying cardiac pathologies through ultrasound and shares techniques for obtaining the apical four-chamber view. The conversation concludes with insights into the impact of ultrasound on patient care and decision-making in emergency situations. In this conversation, Dr. Peter Weimersheimer shares his expertise on cardiac ultrasound techniques, with a focus on the apical four-chamber view and the importance of understanding ventricular shape and function. He discusses practical tips for navigating ultrasound views in critical situations, optimizing imaging techniques, and utilizing patient physiology to enhance imaging quality. The conversation also covers the interpretation of right ventricular size in cardiac arrest and differentiating between the inferior vena cava (IVC) and aorta during ultrasound imaging.

Stroke assessment tools like BEFAST are crucial for swiftly identifying symptoms and expediting treatment. However, language barriers can hinder prompt care for non-English speakers, particularly in the Hispanic community. Developed through a collaborative effort, AHORA adapts the traditional stroke assessment to be culturally and linguistically appropriate for the Spanish-speaking population. Designing Ahora The need for a specific tool became apparent when traditional tools like BEFAST were found to be ineffective for those who did not speak English. After discarding the complex "Rapido," Banerjee's team crafted Ahora, including Marcia Wilson, MD, and Remley Crowe, PhD. This tool was made to mirror BEFAST but is simplified for practical use within the Spanish-speaking population.

Does medicine have dangerous side effects for women? Are the "normal" values we have set for diagnostics possibly endangering specific populations? In this episode of the FOAMfrat podcast, Tyler sits down with Dr.Alyson McGregor, emergency physician and author of Sex Matters, and Tim Redding, EMS educator and lecturer, to discuss the discrepancies in medical testing, diagnosis, and treatment between male and female patients. Dr. McGregor shares her journey of discovering gender bias in medicine, particularly how women's symptoms are often dismissed or mislabeled as psychiatric in nature. The discussion explores how male-centric research has shaped clinical guidelines, leading to underdiagnosis and undertreatment of women across a wide range of conditions—from heart attacks to strokes and even pain management.