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

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:

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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.

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