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:

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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:

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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:

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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:

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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