Advertise on podcast: Loud & Clear: EMS Guiding Principles - Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers

Did you know a perfect first-pass intubation can still count as a failed airway? If your patient desaturates or drops their pressure minutes after the tube goes in, the attempt didn't succeed. Is anyone still watching their pressure, oxygenation, and sedation? In this episode, Ross talks with Dr. Jim DuCanto about face mask ventilation, including how to hold the mask, how to recognize it isn't working, and when to stop and place a supraglottic airway instead of pushing ahead. Then Will brings Eric Bauer on for a discussion about what a successful intubation really means and his PHACTORS checklist for the care that follows. This episode also covers the chin lift grip vs. the CE grip, mask cushions, waveform capnography, flow-limiting and monitoring tools for BVMs, the DASH-1A definition of first-pass success, and the move from BVM to ventilator. In this episode, you’ll learn: Why thin facial hair may make a mask seal harder than a full beard How a CPAP mask with a head strap can help when mask ventilation is difficult Why Eric's program cut ketamine to 0.5 mg/kg for patients with a shock index of 0.9 or higher Why switching from a BVM to a ventilator can drop sats in larger patients, and how clamping the tube during disconnects may help protect recruitment Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Episode 69: EMCRITs Scott Weingart on How to Master the Resuscitation Guests: Dr. Jim DuCanto, MD, Anesthesiologist at Advocate Aurora Health Care Eric Bauer, EdD, MBA, FP-C, CCP-C, C-NPT, NRP, Chief Executive Officer of FlightBridgeED

Your severe head injury patient is altered and hypertensive. Do they need fluid at all, and if so, which one? And in cardiac arrest, are you only restarting the heart, or is getting blood to the brain just as important? Matt talks with Dr. Peter Antevy about why plasma may help rebuild the glycocalyx, the protective lining of blood vessels that sheds after trauma, and why he believes the earliest place to give it is EMS. Then Ross talks with Bruce Hoffman about a swine study testing whether nebulized nitroglycerin during CPR can improve blood flow to the brain. This episode also covers syndecan, cerebral edema and crystalloid, the EPIC TBI study, plasma versus whole blood, point-of-care TBI biomarkers, pulmonary vascular resistance during cardiac arrest, and why EMS clinicians need a seat at the research table. In this episode, you’ll learn: Why Dr. Antevy's agencies are moving toward running plasma in slowly for TBI  How plasma alone may bridge some bleeding patients who don't need red cells Why carotid blood flow dropped after epinephrine in the nitroglycerin study  The new questions raised about vasopressors and flow to the brain Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Nebulized Nitroglycerin Improves Carotid Blood Flow During Cardiopulmonary Resuscitation in a Swine Model of Cardiac Arrest (Kelly et al., Prehospital Emergency Care, 2025) EPIC TBI study results (Spaite et al., JAMA Surgery, 2019) Guests: Dr. Peter Antevy, MD, EMS Medical Director and Founder and Chief Medical Officer of Handtevy Bruce Hoffman, MSN, RN, CFRN, FP-C, Critical Care Transport Nurse with FlightBridgeED

You just handed off a trauma patient everyone in the room knows won't survive. What happens to them after you leave? Where does their family get to say goodbye? Will talks with Amie Lemire, Director of Hospice at UNC Health, about a program that brings hospice into the medical center. Instead of dying in a loud, fast turnover emergency department, critically injured patients can move to comfort care within hours, with a team supporting their families and the clinicians caring for them. This episode also covers the ED direct-admit-to-hospice pathway, the moment a trauma team pivots from resuscitation to comfort care, the 10-bed hospice home in Pittsboro, 13 months of bereavement support for families, and the moral injury clinicians carry after these deaths. In this episode, you’ll learn: Why organ or body donation can take hospice off the table How two hospice RNs stationed in the hospital from 8am-8pm can reach the bedside within 1-2 hours of a referral Why the team may stay at a family's side without formally enrolling the patient, when only hours remain Why inpatient hospice under Medicare is built for active crisis symptom management   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Guests: Amie Lemire, Director of Hospice, UNC Hospice

A trauma patient is hypotensive. Is it hemorrhage? Tension pneumothorax? Cardiac injury? Neurogenic shock? In the first few minutes, the differential can get wide fast, but some causes need to stay at the very top of the list. Recorded at UNC Chapel Hill’s May Day Trauma Conference, Will talks with emergency physician Dr. Maglin Halsey-Nichols about a principle-driven approach to shock in trauma. She explains why hemorrhage should be assumed early, how shock can continue to worsen even after bleeding begins to be controlled, and why trauma resuscitation has to account for more than just blood pressure. This episode also covers manual blood pressure, shock index, whole blood, minimizing crystalloid, permissive hypotension, TXA, pelvic binding, and the less common causes of traumatic shock that can look very different at the bedside. In this episode, you’ll learn: Why shock index may help identify a patient who needs early blood transfusion before hypotension develops How hypothermia, acidosis, coagulopathy, and hypocalcemia can keep hemorrhagic shock spiraling  Why neurogenic shock may look different from most other trauma shock states, including relative bradycardia  Why asking how the trauma happened can uncover an underlying medical emergency such as sepsis or seizure   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Episode 139: When You Can’t Stop the Bleeding: Inside a Massive Trauma Case Guests: Dr. Maglin Halsey-Nichols, Emergency Medicine Physician and Assistant Director of the Emergency Medicine Residency at UNC

A mangled extremity, uncontrolled bleeding, bad weather grounding every helicopter nearby, and a trauma center nearly an hour away. Sometimes the biggest challenge is  figuring out what to do when the ideal plan is no longer available. Ross talks with critical care flight paramedic Jim Phipps about a severe farm-auger injury that pushed multiple teams to adapt in real time. Jim walks through how the responding EMS crew, local hospital, flight team, and receiving trauma center each had to solve a different part of the problem while keeping the patient moving toward definitive hemorrhage control. This episode covers tourniquet reassessment during resuscitation, wide-band and junctional hemorrhage control, hypotensive resuscitation, whole blood, contingency planning, and the communication required when a team realizes its current strategy is not going to work. Jim also explains the workable solution that helped get this patient to the operating room alive. In this episode, you’ll learn: Why a tourniquet that controlled bleeding initially may need to be tightened again  How wide circumferential compression can help when a tourniquet no longer has enough usable tissue to work with What “accuracy, brevity, and clarity” sounds like when a resuscitation team needs to change plans quickly Why asking yourself for 3 things that went well and 3 things to improve can make a post-call reflection more useful Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Episode 136: From Tractor Rollovers to Grain Entrapment: A Field Guide to Farm Emergencies Guests: Jim Phipps, Critical Care Flight Paramedic, UNC Air Care

Pregnancy can make even experienced clinicians second-guess decisions. Can you image the patient? Can you cardiovert? Should the trauma assessment change? And at what point does the fetus become part of the resuscitation? Will talks with maternal-fetal medicine physician Dr. Johanna Quist-Nelson about what matters when caring for a pregnant trauma patient, where fetal assessment fits into the trauma survey, how pregnancy changes positioning and oxygenation goals, why necessary diagnostic imaging should not be withheld, and what clinicians should understand about maternal cardiac arrest and resuscitative hysterotomy. She also addresses the emotional impact these rare, high-stakes cases can have on families. In this episode, you’ll learn: Why bleeding may be an important clue after trauma even when the pregnant patient appears stable How lateral uterine displacement can improve venous return without compromising chest compressions Why an unstable arrhythmia in pregnancy should not automatically delay electrical cardioversion What a low fibrinogen level can signal differently in a pregnant trauma patient  Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. MomBaby.org UNC Center for Maternal and Infant Health Perinatal Emergency Checklists Guests: Dr. Johanna Quist-Nelson, maternal-fetal medicine physician

The hardest calls fall apart when communication is unclear, roles blur, feedback feels personal, and the team starts working around each other instead of with each other. Today, Ross and Will talk with Dr. Daryl Johnson, Adult Trauma Medical Director for the UNC Health Trauma Program, about what it takes to build teams that can perform consistently under pressure, how leaders can manage disagreements without shutting down valuable input, and why relationships built during ordinary shifts matter. Dr. Johnson also shares how UNC uses shared processes, simulation, video review, coaching, and deliberate repetition to create consistency across an ever-changing team, and why excellence has to become something clinicians practice on ordinary cases rather than something they hope to switch on for a big one. In this episode, you’ll learn: What a question or disagreement from a teammate may signal about a leader How reviewing “game film” can help clinicians recognize their own blind spots  Why lower-acuity calls are an opportunity to rehearse the habits you’ll need during a resuscitation What “smooth is fast” really means when the goal is to reduce chaos    Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. UNC Health Trauma Program TeamSTEPPS Guests: Dr. Daryl Johnson, Adult Trauma Medical Director, UNC Health Trauma Program

The mechanism behind agricultural emergencies can completely change the risk to both the patient and the responders arriving to help. Ross talks with Jessica Wilburn, Agromedicine Nurse Coordinator, and Maggie Denning, Outreach Coordinator with the North Carolina Agromedicine Institute, about the injuries and environmental hazards first responders may encounter in agricultural communities. They cover tractor rollovers, livestock injuries, pesticide and fumigant exposure, grain-bin entrapment, hydraulic injection injuries, and machinery involving augers and power takeoff shafts. The conversation also covers responder safety, including how to recognize when machinery is still energized, why a barn or greenhouse call may involve dangerous chemical exposure, and how local farmers can sometimes be one of your best sources of information. In this episode, you’ll learn: Why farmers often minimize injuries, and why “minor” complaints deserve a closer look Why grain bins and manure lagoons can create secondary victims when rescuers enter How a tiny hydraulic-fluid puncture wound can threaten an entire extremity despite looking benign at first What a first responder should do first when approaching moving farm machinery   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. North Carolina Agromedicine Institute Guests: Jessica Wilburn, Agromedicine Nurse Coordinator, North Carolina Agromedicine Institute Maggie Denning, CNA and Outreach Coordinator, North Carolina Agromedicine Institute

The First 60 Seconds After ROSC: How To Prevent Re-Arrest How do you improve your resuscitation systems beyond the ACLS algorithm? Will talks with Ian Blanchard, Senior Scientist for Alberta’s provincial EMS system about the “frame of survival” and why rehearsing equipment placement and vector change can make critical actions nearly automatic when the call comes in. Then, Ross talks with Mike Humphrey of Lethbridge Fire and Emergency Services about what happened when his team reviewed their cardiac arrests and discovered a recurring pattern: post-ROSC hypotension followed by a near 50% re-arrest rate. Their response was to redesign post-ROSC care around the first 60 seconds to prevent life-sustaining therapies from disappearing during the transition of care. In this episode, you’ll learn: What “doing reps in the clinical gym” looks like when you don’t have access to a high-fidelity simulator Why moving a cardiac-arrest patient too early can undermine CPR quality and make resuscitation worse What 1 minute blood pressure reassessments can reveal that a single “good” post-ROSC pressure may miss Why a vasopressor-dependent patient should stay on the EMS stretcher  The best time to prepare for vector change, pit-crew roles, and post-ROSC care   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Canadian Resuscitation Outcomes Consortium Resuscitation Academy International Liaison Committee on Resuscitation Episode 133: Post-ROSC Care & Pacing: Prove the Perfusion Guests: Ian Blanchard, former paramedic and Senior Scientist for Alberta’s provincial EMS system Mike Humphrey, Lethbridge Fire and Emergency Services

Getting a pulse back feels like a win. Seeing pacer spikes and something that resembles a pulse feels reassuring. But in both situations, the monitor can make you feel better before the patient actually is. Geoff Murphy of Master Your Medics breaks down the fragile minutes after return of spontaneous circulation. He explains why hypotension deserves immediate attention, how falling end-tidal CO2 can warn that cardiac output is deteriorating, and when fluids can serve as a short bridge to vasopressors. Then, paramedic Jacob Miller challenges some of the assumptions clinicians learn about transcutaneous pacing. He discusses pad placement, pacing current, ultrasound, pharmacologic support, and why clinicians need to keep reassessing even after they think they have capture. In this episode, you’ll learn: Why an initially normal blood pressure after ROSC can be falsely reassuring How skeletal muscle contraction during pacing can create ECG artifact and a false sense of mechanical capture What can improve your chances of capturing a patient when transcutaneous pacing is needed Why practicing the pacer during routine monitor checks can make a rare, high-stress call much easier to manage Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Interested in ABLS Now? Our listeners get 10% off with code LOUD26POD. Jacob’s Resources: Article with images of false vs true electrical capture: Kimbrell J, Kreinbrook J, Poke D, et al. False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehosp Emerg Care. 2024;28(7):928-936. doi: 10.1080/10903127.2024.2321287   Link to Scott Weingart's EMCrit podcast episode discussing false positive SpO2 signal without actual capture:  https://emcrit.org/emcrit/tcp-pulse-ox-fail/   Jacobs website with handout version of my slides:  https://jacobmilleracnp.com/slides/   Guests: Geoff Murphy, Founder and Lead Educator of Master Your Medics Jacob Miller, paramedic, flight nurse, critical care nurse, nurse practitioner, and DNP

Burn patients can create a disproportionate amount of anxiety. The calls are uncommon, the injuries can be visually overwhelming, and it is easy to get distracted by the burn itself. Ross and Will talk with Mark Johnston, a longtime Advanced Burn Life Support instructor and burn program leader at Regions Hospital, about simplifying prehospital burn care. Mark explains how most burn patients should be approached and why you need to resist the urge to make wound care the first priority. They also dig into the findings that should make you truly concerned about an inhalation injury, how to estimate total body surface area, and which smaller burns still warrant burn-center evaluation. In this episode, you’ll learn: Which airway findings increase concern for inhalation injury Why the simple 125/250/500 mL-per-hour approach can be more useful in the field than calculating a full Parkland formula How mechanism changes your priorities in thermal, chemical, electrical, and enclosed-space burns How wet dressings and aggressive wound care can increase heat loss or distract clinicians from early interventions   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August. The Emergency Mind: Wiring Your Brain for Performance Under Pressure, by Dan Dworkis, MD PhD Peak Performance Under Pressure, by Stephen Hearns Episode 109: Understanding the EMS Power Curve Guests: Mark Johnston, BSN, RN, TCRN, Burn Program Manager at Regions Hospital

Readiness is about more than knowing the medicine. It’s about creating the conditions for patients, families, and clinicians to feel safer and more capable when the situation is unfamiliar, overwhelming, or high risk. First up, Boston MedFlight flight nurse Nicole King discusses neurodivergence, sensory overload, and how traditional EMS behaviors can unintentionally escalate distress. She explains why slowing down, reducing stimuli, and involving caregivers can completely change the experience for patients who are struggling. Then, Ross talks with pediatric flight nurse and Blakery Content creator Christopher Blake about pediatric readiness and why confidence on low-frequency, high-risk calls has to be built before the tones drop. They discuss pediatric emergency care coordinators, agency-wide readiness, and using QA/QI. In this episode, you’ll learn: How to recognize when behavior may be the result of sensory overload or difficulty processing the environment Why pictograms, fidget toys, headphones, sunglasses, and weighted pressure can reduce escalation  How a Pediatric Emergency Care Coordinator can help an agency identify gaps Why family-centered communication can reduce fear and improve cooperation How to adapt your assessment when a patient cannot tolerate standard vital-sign monitoring    Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August.   Pediatric Readiness Assessment KultureCity Ben’s Blue Bags and Carter Kits Emergency Medical Services for Children Innovation & Improvement Center Birth Vibes: Stories & Strategies for An Empowered Birth, by Jen Hamilton Guests: Nicole King, flight nurse, Boston MedFlight Christopher Blake, pediatric flight nurse and creator of Blakery Content

What differentiates heat stroke from heat exhaustion? Once central nervous system dysfunction appears, every minute spent at an elevated core temperature increases the risk of permanent neurologic injury or death. Ross and Will talk with emergency physician and wilderness medicine specialist Dr. Greg Doctor about the full spectrum of heat-related illness – from heat cramps, rash, and edema to syncope, exhaustion, and life-threatening heat stroke. They discuss how to avoid anchoring on the heat when a patient loses consciousness and what the critical dividing line between heat exhaustion and heat stroke is. They also examine exercise-associated hyponatremia, drug-related hyperthermia, fluid selection, and the patients who may remain at risk even after they initially appear to recover. In this episode, you’ll learn: How to distinguish heat syncope, heat exhaustion, and heat stroke Why central nervous system dysfunction and an elevated core temperature matter most How to choose between cold-water immersion, continuous water and fanning, ice sheets, and ice-water slurry techniques When transport should be delayed for on-scene cooling, and when cooling should continue   Resources: Wilderness Medical Society Clinical Practice Guidelines for the Prevention & Treatment of Heat Illness: 2024 Update Unlocking Syncope with Matt Mendes The Critical Care of the Sick Runner: A Comprehensive Guide with Dr. Whitney Barrett Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August. Guests: Dr. Greg Doctor, emergency physician and wilderness medicine specialist

Most people picture a master clinician as the person in the room who knows every answer. In reality, mastery looks like the opposite, and admitting what you do not know. Ross talks with FlightBridgeED co-founder Eric Bauer about the “rage to mastery”, the advice that kept him in EMS after a series of difficult calls nearly drove him away, why expertise is perishable, and how ego creates resistance to learning. Then, Will speaks to Master Your Medics founder Geoff Murphy about a medication error that changed how Geoff understood team culture. They explore what happened, and why psychological safety does not lower the standard.   In this episode, you’ll learn: Why sustainable learning habits are more valuable than ambitious goals How experienced clinicians can model vulnerability without undermining their credibility What to look for in a mentor who will challenge blind spots  How to turn an uncomfortable call into action-oriented preparation for the next patient   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August. Guests: Eric Bauer, CEO and Co-Founder of FlightBridgeED Geoff Murphy, Founder and Lead Educator of Master Your Medics

The calls that scare clinicians the most are often the ones they have the fewest opportunities to practice. So what happens during a rare, high consequence emergency? First, Jennifer Barnhart of Austin-Travis County EMS and Sergeant Luke Serrato of the Austin Police Department discuss the response to a mass casualty shooting on Austin’s Sixth Street. Then, Ross talks with Allen Wolfe about three unusual burn and blast-injury cases. They discuss when a smaller burn may still warrant transfer to a burn center, how to recognize an airway that may require an early surgical approach, what a blast mechanism can reveal about hidden injuries, and why protecting burned tissue cannot come at the expense of protecting the airway. In this episode, you’ll learn: How shared language and closed-loop communication help EMS and law enforcement move together  Why responders may need to pass ambulatory or vocal patients to reach those who cannot self-rescue What disrupted tympanic membranes, clothing patterns, circumferential facial burns can reveal   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off and a chance to win a free subscription. Enter before August 1, 2026.   Guests: Jennifer Barnhart, Clinical Specialist, Austin-Travis County EMS Sergeant Luke Serrato, Austin Police Department Allen Wolfe, Senior Director of Clinical Education and Clinical Nurse Specialist at Life Link III