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Loud & Clear: EMS Guiding Principles - Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers: Daily Summaries Delivered
by Ross Orpet, Paramedic turned EMS Physician
Paramedic training is over, you’re in the front seat now. Whether day 1 or day 1,000 you can’t shake the fear you’re underprepared. You were taught to systematically decide if A... do B. But what if “A” wasn’t in the book? The truth is each emergency call is too unique to teach the right response to every situation. We need to go beyond algorithmic thinking and understand deeper principles, the WHY behind the algorithm. When every decision counts you want to rely on a framework that will guide you when things don’t make sense. Through discussions with experts, review of evidence-based best practices, and real-world case studies we teach you one step past what you learned in paramedic school. But all of this advanced education is connected back to the guiding principles that answer the question- “at the end of the day, what actually matters to the patient I have in front of me?”
Latest Episodes
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- Yesterday57 min
Training for the Big Call: How Emergency Teams Can Build Better Performance Under Pressure
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
- 1 weeks ago51 min
From Tractor Rollovers to Grain Entrapment: A Field Guide to Farm Emergencies
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
- 2 weeks ago35 min
The First 60 Seconds After ROSC: How To Prevent Re-Arrest
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
- 3 weeks ago1h 6m
Post-ROSC Care and Pacing: Prove the Perfusion
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 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 with code LOUD26POD. Guests: Geoff Murphy, Founder and Lead Educator of Master Your Medics Jacob Miller, paramedic, flight nurse, critical care nurse, nurse practitioner, and DNP
- 4 weeks ago1h 2m
Burn Care in EMS: What Actually Matters in the First 15 Minutes
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
- Aug 17, 202651 min
Readiness Beyond the Medicine: Neurodivergence, Pediatrics, and Better Communication
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
- Aug 10, 202647 min
Heat Stroke: Recognition, Cooling, and Transport Decisions
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
- Aug 3, 202648 min
The Pursuit of Mastery: Preparation, Mentorship, and Learning From Mistakes
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
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About Loud & Clear: EMS Guiding Principles - Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers
Paramedic training is over, you’re in the front seat now. Whether day 1 or day 1,000 you can’t shake the fear you’re underprepared. You were taught to systematically decide if A... do B. But what if “A” wasn’t in the book? The truth is each emergency call is too unique to teach the right response to every situation. We need to go beyond algorithmic thinking and understand deeper principles, the WHY behind the algorithm. When every decision counts you want to rely on a framework that will guide you when things don’t make sense. Through discussions with experts, review of evidence-based best practices, and real-world case studies we teach you one step past what you learned in paramedic school. But all of this advanced education is connected back to the guiding principles that answer the question- “at the end of the day, what actually matters to the patient I have in front of me?”
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