Podcasts · Education

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

Ross Orpet, Paramedic turned EMS Physician

143 episodes · Explicit

Paramedic training is over, you’re in the front seat now. Whether day 1 or day 1,000 you can’t shake the fear you’re underprepared. You were taught to systematically decide if A... do B. But what if “A” wasn’t in the book? The truth is each emergency call is too unique to teach the right response to every situation. We need to go beyond algorithmic thinking and understand deeper principles, the WHY behind the algorithm. When every decision counts you want to rely on a framework that will guide you when things don’t make sense. Loud & Clear: EMS Guiding Principles is your resource to build that framework. Through discussions with experts, review of evidence-based best practices, and real-world case studies we teach you one step past what you learned in paramedic school. But all of this advanced education is connected back to the guiding principles that answer the question- “at the end of the day, what actually matters to the patient I have in front of me?” Our mission is to elevate your practice and help you improve patient outcomes in every emergency situation. You may not feel ready, you may not feel like you know enough, but by understanding the guiding principles of emergency medicine you can become an expert EMS clinician. Because what you do matters. Loud & Clear: EMS Guiding Principles is an EMS Cast LLC production

Episodes page 1 of 3

  1. Plasma for TBI and Nebulized Nitro in Cardiac Arrest: A Fun Look Into Early Research with Dr. Peter Antevy and Bruce Hoffman

    · 52 min · Episode 142 · Explicit

    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…

  2. When Trauma Care Turns to Comfort: Inside a Trauma Center Hospice Program

    · 15 min · Episode 141 · Explicit

    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…

  3. Shock in Trauma: What Paramedics Need To Recognize

    · 14 min · Episode 140 · Explicit

    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…

  4. When You Can’t Stop the Bleeding: Inside A Massive Trauma Case

    · 34 min · Episode 139 · Explicit

    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…

  5. Maternal Trauma Emergencies: What Changes in the Pregnant Patient

    · 19 min · Episode 138 · Explicit

    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…

  6. Training for the Big Call: How Emergency Teams Can Build Better Performance Under Pressure

    · 58 min · Episode 137 · Explicit

    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…

  7. From Tractor Rollovers to Grain Entrapment: A Field Guide to Farm Emergencies

    · 52 min · Episode 136 · Explicit

    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,…

  8. The First 60 Seconds After ROSC: How To Prevent Re-Arrest

    · 36 min · Episode 135 · Explicit

    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…

  9. Post-ROSC Care and Pacing: Prove the Perfusion

    · 1 h 06 min · Episode 134 · Explicit

    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…

  10. Burn Care in EMS: What Actually Matters in the First 15 Minutes

    · 1 h 02 min · Episode 133 · Explicit

    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…

  11. Readiness Beyond the Medicine: Neurodivergence, Pediatrics, and Better Communication

    · 52 min · Episode 132 · Explicit

    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.…

  12. Heat Stroke: Recognition, Cooling, and Transport Decisions

    · 48 min · Episode 131 · Explicit

    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…

  13. The Pursuit of Mastery: Preparation, Mentorship, and Learning From Mistakes

    · 49 min · Episode 130 · Explicit

    Most people picture a master clinician as the person in the room who knows every answer. In reality, mastery looks like the opposite, and admitting what you do not know. Ross talks with FlightBridgeED co-founder Eric…

  14. Mass Casualty Readiness, Burn Decisions, and the Fundamentals That Save Lives

    · 1 h 03 min · Episode 129 · Explicit

    The calls that scare clinicians the most are often the ones they have the fewest opportunities to practice. So what happens during a rare, high consequence emergency? First, Jennifer Barnhart of Austin-Travis County…

  15. What the Evidence Really Says About Cervical Collars with Dr. Jeff Jarvis and Dr. Ben Abo

    · 1 h 16 min · Episode 128 · Explicit

    The hardest part of evidence-based medicine is not finding a paper. It is deciding whether that paper should change what you do on your next shift. First, we talk with Dr. Jeff Jarvis about how to evaluate medical…

  16. The Three Building Blocks of Trust in EMS

    · 1 h 09 min · Episode 127 · Explicit

    Trust is the architecture behind every patient interaction you run. Dr. Cory Scheer, author of Closing the Trust Gap, has identified three evidence-based building blocks of trust: competency, problem-solving, and care…

  17. The Skill Is Not The Hard Part

    · 30 min · Episode 126 · Explicit

    The hardest part of a bad call is rarely the algorithm. In two different interviews I explore some human traps of running an EMS call. I talk with Danny and Rance from DNR Prehospital Education about a choking arrest,…

  18. Treat Mom First: Amniotic Fluid Embolus and Other Peri-partum Emergencies

    · 55 min · Episode 125 · Explicit

    A postpartum patient does not need to look dramatic to be in real danger. In this episode from FAST 26, Ross talks with Amy Loucks about pregnancy-related deaths, maternal care deserts, postpartum warning signs,…

  19. Pressure Matters: Oxygenation vs. Ventilation in Pre-Oxygenation with Scott Weingart

    · 31 min · Episode 124 · Explicit

    Pre-Oxygenation is not just putting oxygen on the patient and hoping the sat buys you enough time. In this episode, Ross talks with Scott Weingart after his FAST26 talk on preventing peri-intubation arrest. They get…

  20. Your Checklist Is Making You Worse: Why Pilots Use Checklists and Paramedics Don't

    · 1 h 07 min · Episode 123 · Explicit

    A checklist should reduce cognitive load. So why does yours make things worse? Airline pilot and safety officer Glenn Fisher breaks down how aviation refined checklists over decades of crash data and human factors…

  21. Pediatric Sepsis with Dr. Peter Antevy

    · 33 min · Episode 122 · Explicit

    Pediatric sepsis is easy to miss because the first hour often looks ordinary. Kids compensate, until they don't. In this episode, Will Berry talks with Dr. Peter Antevy about the case that still bothers him and why…

  22. How to Build Procedural Skills - That Actually Stick

    · 1 h 38 min · Episode 121 · Explicit

    Most EMS skills training creates an illusion of competence. You drill a procedure, check a box, and move on. But what does the research actually show about competency and retention? Dr. Jason Hine (EM physician,…

  23. How to Fail Better in EMS: A Framework for Growth

    · 16 min · Episode 117 · Explicit

    Stephanie Suzadail's favorite word is "fail." She'll tell you why and how we should embrace it. In this episode she walks through the difference between failure that builds you and failure that breaks you. Why…

  24. The Call Nobody Trained You For — Jim Schmidt on Domestic Violence Recognition

    · 1 h 12 min · Episode 115 · Explicit

    Most medics walk onto a domestic violence scene armed with instinct and not much else. Jim Schmidt thought 20 years in the fire service had prepared him for anything — until he had to identify his stepdaughter Gabby…

  25. Great Mentors Shape Better Clinicians

    · 20 min · Episode 114 · Explicit

    Don't Be A Field Training Officer Be A Field Training Mentor. Field training is about more than teaching skills, it shapes culture, standards, and the kind of clinician someone becomes. In this episode, Ross sits down…

  26. Frozen Fingers, Time Is Tissue: The Prehospital Approach to Frostbite

    · 1 h 00 min · Episode 113 · Explicit

    Frostbite is more dangerous than it looks and easier to make worse than you think. In this episode, Ross and Will sit down with Dr. Greg Doctor, a wilderness medicine specialist and emergency physician practicing in…

  27. Suction First: Dr. DuCanto on the SALAD Technique for the Contaminated Airway and What Comes Next

    · 30 min · Episode 112 · Explicit

    The contaminated airway is one of the most unforgiving calls in prehospital medicine. Blood, vomit, debris — your laryngoscope goes in and you're blind. For decades, paramedics managed this with tools designed for a…

  28. Wired to Fail: The Science of Human Error in EMS

    · 11 min · Episode 111 · Explicit

    What if the mistake wasn't your fault... but it's still your responsibility? That's the tension Shay Montgomery sits with every time she talks about the day she flew to a scene without the drug bag. Shay is a flight…

  29. Dump Kits and Checklists: Why Expert Paramedics Still Crash

    · 18 min · Episode 110 · Explicit

    Miss your first intubation attempt and your patient's risk of adverse events jumps sevenfold. By the third attempt? Nearly guaranteed complications. This isn't about your anatomical knowledge or practice hours—expert…

  30. Feeling Behind the Curve? Understanding the EMS Power Curve Will Help You Stay Ahead

    · 1 h 17 min · Episode 109 · Explicit

    Behind the curve. We've all heard it. Most of us have lived it. That sinking feeling when you're mentally three steps behind where the call actually is. The concept of the Power Curve comes from aviation—pilots need to…

  31. Stupidity in EMS: The causes and remedies

    · 23 min · Episode 108 · Explicit

    You're not making mistakes because you're dumb. You're making mistakes because of seven predictable factors—and once you know them, you can control them. Kris Kaull delivered a masterclass at FASTCAN on the hidden…

  32. Anaphylaxis + Asthma: When Standard Anaphylaxis Treatment May Not Be Enough (AMAX4 Explained)

    · 19 min · Episode 107 · Explicit

    This episode tells the tragic story of Max McKenzie, a teenager with asthma who died from anaphylaxis despite receiving "standard care." His death led his father, Dr. Ben McKenzie, to develop the AMAX4 algorithm.…

  33. The Habit Loop: How Master EMS Clinicians Build Unconscious Competence Through Habits

    · 16 min · Episode 106 · Explicit

    Struggling to remember every protocol in high-pressure medical situations? You're not alone—and memorizing everything isn't the answer. Join us for this game-changing conversation with Jean Francois Couture,…

  34. Hypothermia Rescue: Cardiac Arrest in a Tree Well

    · 40 min · Episode 105 · Explicit

    What happens when a 24-year-old woman is found frozen in a tree well after last being seen 8 hours prior, with a core temperature of 62°F (17°C)? In this extraordinary case, paramedic Miles Randell and his team…

  35. When The Anatomy Is Gone: Facial Trauma Airway Management

    · 24 min · Episode 104 · Explicit

    What do you do when the anatomy you've memorized simply doesn't exist anymore? When a patient's entire face is gone, and your standard airway management tools won't work? This is where training meets reality. Critical…

  36. Stop Building Resilience, Strengthen Your Resistance

    · 25 min · Episode 103 · Explicit

    Discover the difference between resistance (your daily shield built through sleep, nutrition, relationships, and spiritual wellness) and resilience (the anaerobic sprint you can't maintain forever). Recorded on-site…

  37. What If They Find Out I'm A Fraud? - Imposter Syndrome in EMS

    · 23 min · Episode 102 · Explicit

    Ever cried in the ambulance because you felt completely overwhelmed? Sophie Fuller has—and she's done something powerful with that experience. In this raw discussion, the Life and Sirens podcast host shares her most…

  38. Why Those With Addiction Don't "Just Change" - Opioid Crisis Reality for EMS

    · 1 h 00 min · Episode 100 · Explicit

    Death is the Bottom: Why EMS Must Rethink Opioid Use Disorder Treatment "Nobody told me that the bottom had a basement and the basement had a trap door." This powerful quote from a grieving mother reveals the tragic…

  39. When to Act: Mastering Vasopressors in 2025

    · 14 min · Episode 101 · Explicit

    What do you do when the blood pressure monitor shows a number you don’t like? Most providers hit the button again—but what if it’s real? In this episode, we’re joined by critical care transport specialist James…

  40. The 5 Levels of EMS Mental Breakdown & How to Escape Them

    · 37 min · Episode 99 · Explicit

    Why do some paramedics stay unshakable under pressure while others crumble on the exact same call? The answer isn't about years of experience—it's about understanding the neuroscience of stress and having the right…

  41. Following Evidence or Following the Crowd? The Truth About Evidence-Based Medicine with Dr. Eddy Lang

    · 16 min · Episode 98 · Explicit

    What if the evidence hierarchy you learned in school is incomplete? Dr. Eddie Lang, who helped develop the GRADE system now used by WHO and major resuscitation councils, explains why clinical practice guidelines—not…

  42. Toxidromes Demystified

    · 36 min · Episode 97 · Explicit

    Understanding the toxidromes provides you with vital diagnostic tools in high-stakes environments. In this episode, we break down the clinical patterns that define. Want to stay ahead of the top 1% in EMS and build…

  43. Rescue Breaths: Demystifying the Physiology of Safe and Effective BVM Ventilation

    · 27 min · Episode 96 · Explicit

    Melody Bishop helps us simplify the physiology of bag-valve-mask (BVM) techniques. This episode highlights common mistakes like insufficient exhalation time, discusses driving pressure, and explains the importance of…

  44. Prehospital Blood, Trauma Arrest, Hypertension in Pregnancy, and Diltiazem in Afib with RVR

    · 50 min · Episode 95 · Explicit

    Dr. Jeff Jarvis, EMS medical director and host of the EMS Lighthouse Project, delves into the latest emerging EMS literature and guidelines from the National Association of EMS Physicians. We explore best practices for…

  45. Unlocking the Hidden Keys to Calm Under Chaos: How Simple Tools Like A Checklist Can Elevate Your Care

    · 21 min · Episode 94 · Explicit

    What's the real difference between paramedics who stay calm under pressure and those who panic when everything goes wrong? It's the ability to already know what comes next. In this episode we explore the power of…

  46. EXCITING NEWS! FIND OUT WHAT WE'VE BEEN WORKING ON.

    · 6:56 · Episode 93 · Bonus · Explicit

    Were have we been? Well, the truth is, we've been incredibly busy working on some really exciting projects. If you're interested in joining the founding members cohort of The Loud & Clear Fellowship Course reach out…

  47. Engineering Simplicity in Crisis: Mastering Airway Management Through Systematic Approaches With Dr. Rich Levitan

    · 1 h 10 min · Episode 92 · Explicit

    Renowned airway enthusiast, Dr. Rich Levitan, on mastering airway management. Explore his approach to simplifying complex tasks into achievable and believable steps. Every complexity incurs a debt to crisis…

  48. The Cost of Saving Lives: Complications Arising from Pre-Hospital Tourniquet Use

    · 51 min · Episode 91 · Explicit

    We dive into the latest emergency medicine research evaluating the complications following pre-hospital tourniquet use. Dr. Ben Li, an expert in emergency medicine literature reviews a 2023 study titled 'The Cost of…

  49. Why Two Paramedics Watched Their Trainer Nearly Kill a Patient (And Said Nothing): How Lessons From The Aviation Industry Could Have Prevented It

    · 1 h 15 min · Episode 90 · Explicit

    A field trainer administers a non-indicated medication while two trainees watch in silence. Sound familiar? In this eye-opening episode, we dive deep into how the aviation industry transformed from a punitive,…

  50. The Art of Managing Agitated Patients

    · 1 h 19 min · Episode 89 · Explicit

    Effective agitated patient management requires a fundamental shift from viewing these encounters as behavioral problems to recognizing them as medical emergencies with underlying pathophysiological processes. By…

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