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

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:

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