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

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:

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Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.

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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

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

Want more? Sign up for our weekly newsletter, The Confidence Dispatch.

Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship.

Interested in ABLS Now? Our listeners get 10% off with code LOUD26POD.

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:

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