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

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:

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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

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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:

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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.

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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

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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