EMS cast

30/01/2025

Are you a new paramedic having problems with confidence, decision-making, or imposter syndrome? This is totally normal! We are doing research for a project to help paramedics go from indecisive and feeling like an imposter to calm and confident providers—and we would love to talk to you.
If you’re struggling with this, comment below or send us a direct message so we can help!

28/01/2025

22/01/2025

If you are a new paramedic having problems with confidence, decision-making, or imposter syndrome? This is totally normal! We are doing research for a project to help paramedics go from indecisive and feeling like an imposter to calm and confident providers—and we would love to talk to you.
If you’re struggling with this, comment below or send us a direct message so we can help! 🚑✨

09/01/2025

check out The Resus Tailor! Purpose built bags and kits to meet your needs. We are proud to work with this awesome company. We believe in their vision that well thought out equipment and equipment storage can enhance patient care.

28/12/2024

Frustrated with your gear layout?

This is common in systems everywhere and at every care level. I even hear it in emergency departments.

Are things stored where there is enough room, or are their storage positions chosen to maximize your work as a care provider?

Are zippers or buckles bursting?

Did your kit or bag work well but a new piece of gear was introduced or a package was changed making it harder to fit?

One criticisms I have of common EMS gear:
Someone laid out the elastic loops and little pockets with specific needs in mind, but we, as the user, don’t know your scheme. We end up fitting our gear to your bag. Your bag should be fit to our gear.

If these sentiments resonate with you, check out . We are excited to be sponsored by this great company. Their thoughtful designs intend to improve patient care by helping you have your equipment organized and where you need it. You can work with them to design an option that meets your specifics.

20/12/2024

Training to reduce errors or training to build expertise.
 
These are two viewpoints that are not opposites but do stand in tension to one another.  There is a great conversation on the .live podcast which touches on this subject. Training to strictly reduce errors focuses on protocols, policies, and procedures.  The trainer watches the learner and pounces when they see something perceived as wrong.  The learner then adapts to do it the trainer’s way knowing that it will prevent a future “pouncing.”  There are some critical flaws with training this way.  First, you are building in the learner an adherence to a way.  This way is the way of one person, the trainer, and promotes a mentality of the learner trying to do things the instructor’s way. In my opinion, the critical thinking horsepower of the learner is then dedicated to always trying to figure out what their trainer wants so they can avoid negative feedback, and can feel successful. This doesn’t always have to be aggression from the trainer. Trainers the constantly redirect politely are at risk of this too.
 
Training for expertise, builds up the critical thinking ability of the learner and shepherds them as they develop their own ability to work through a situation leaning on the guidance and expertise of respected colleagues while they see and learn things for the first time.  A good trainer recognizes key decision points or “forks in the road” and asks the learner what their options are in that moment.  Then discussing with the learner pros and cons of those options. If you are interested in learning more on your own find articles related to cognitive skills training versus procedure based training.

25/10/2024

Join us as we discuss Just Culture with Chris. He gave a great talk at hosted by on the topic! Just Culture has become somewhat of a buzzword but its core tenets of finding system error is of critical importance for EMS agencies. Chris, of fame shared stories of handling errors as an EMS supervisor. His perspective and humor do not disappoint!

18/10/2024

This kit went on a rafting trip. I bring paramedic equipment on wilderness trips. I tend to be more minimalist, but carry some stuff.
That said, why do I carry what I carry? Why do you carry what you carry? How does context impact these decisions?
It all depends…there’s no answer. It’s complex. What’s your comfort level? What’s your training? What do you have? What can you improvise? How much space?

As these questions mount, you have to fall back on principles.

1. Limited Space
In this situation I was limited to the size of my pelican case, which, was still rather large.
2. What is most probable?
On a half day whitewater trip some of the worst case scenarios that can be encountered are trauma, drowning, anaphylaxis, hypoglycemia, severe asthma…
3. What outlier situation should I pack for?
For me I think about managing an airway, and I don’t necessarily mean intubation. Intubating a patient in the wilderness with no ability to continuously monitor ETCO2 is not safe for the patient. I’m not saying never, but first do no harm.
4. What do I own?
I don’t have everything and can’t get everything, it’s the reality. Instagram makes it look easy to get medical gear. That stuff costs money…
5. Given the context, when can I actually make a difference and when do I give the illusion of making a difference?
This is a morbid reality of being in austere environments. Sometimes the context wins. Does that mean we do nothing? No, we are going to do what we can and show their friends and family that we are doing something, but we keep in the back of our mind the reality.

About this kit; This Pelican case was submerged in flowing water during a wrapped boat. It did have some water intrusion. Pelican cases are great, but in forceful fast moving water, some does get in. I pack my stuff in ziplocks. I carried an airway kit (BLS, Supraglottic, ET, and cric; just because I have it doesn’t mean I am going to use it. I will exercise situational discretion). IV/ med kit. BVM. Trauma kit. Lightweight litter (Sure, you can improvise a litter, but carrying someone over rough terrain is difficult. Why not give yourself a tool).

15/10/2024

How often do you intubate?

Are you working in a system that utilized supraglottic airways (SGAs) as their primary airway device? When you respond to a cardiac arrest is a King/ iGel/ AirQ your go-to airway?

As frontline providers you may not be in positions to influence your system’s stance on something as debated as prehospital endotracheal intubation, but you can take ownership over your own skills and how much you practice and study. Where am I going with this?

Why is there a picture of the Magill forceps on this post?

Utilization of the Magill forceps to relieve a tracheal obstruction is something that is time sensitive and paramedics in the field can and will be called upon to intervene. Seconds and minutes matter in someone with a truly obstructed trachea. YOU can save this patient, in the field. Utilization of the Magill forceps is inextricably linked to another critical skill, laryngoscopy. If you rarely get a chance to look in someone’s airway with a laryngoscope you will not suddenly be a pro when their airway has a big chunk of meat in it and everyone is looking to you as a life saver.

You may not be a in position to change your agencies protocol or stance towards use of ET intubation as a frontline intervention, but you need to recognize the holes in your skills and work to fill them.

Practice your laryngoscopy whenever you get a chance. If that is on a mannequin, great. Better than no practice. Try different mannequins. Each one is different, similar to humans. Use it as an opportunity to hone the mechanics of using your tools.

Check out our episode with Dr. Lauria about some of these mindset steps you can take. 1. Be Prepared. 4. 100% Commit. 7. Keep your clinical blade sharp. 9. Improvise, adapt, overcome.

Our current episode, Are They Choking? Talk about other challenges associated with food impaction. Check us out!

03/10/2024

When is the scene safe? The topic of scene safety is discussed frequently with varying degrees of opinion and tolerance for risk.
What is our take?

We try to avoid binary answers, it is safe or it isn’t. We look at things in terms of principles.
-What hazards are you aware of, and can you mitigate them?
-If you can’t mitigate them, is the risk acceptable or worth it?
-Know the situations you frequent with known uncontrolled hazards(side of the highway)

A common situation EMS providers find themselves in is staging for an act of violence, shooting, assault, domestic, etc. commonly EMS stages and waits for a “scene secure” from whomever. Why? What changed on that scene?
Sometimes the only thing that changes is law enforcement arrived. Does that guarantee your safety?

We are not typically in positions to change whole systems, but we can control what we choose to take ownership of; our safety.

This photo is of a helicopter tailboom. The danger sign points to the tail rotor, which, when spinning can and will kill you. Not a bigger safety threat than death. That said when we fly to a shooting we are told over the radio, “scene is secure.”

Not a knock on my dispatch colleagues but more a commentary; scene is not actually safe.

Watch out for your safety. That is paramount. Also balance we are in the business of helping patients. Unnecessary delays for an illusion of safety doesn’t help them.

24/09/2024

I responded to a critical care transport for a septic patient. Quite sick, on vasopressors, & needed an ICU.

The patient was angry and uncooperative. Just like calls on the streets…

He was upset about a bag with important belongings and documents. He even said, “I’m not going with you unless I see my bag.”

These were my thoughts, “The bag ain’t here, I don’t know where it is, we probably can’t get it, and this guy is coming with me no matter what.”
I also knew right away, this isn’t about his bag. This is about a man who has lost all freedom. He is reliant on others for everything. The bag was his last chance to have some control.

So…faced with a decision. How do I communicate?

I started with questions and listening. “Sir, tell me what you know about your bag.”

Once I listened to his story and endured some insults I said this:
“Sir I can tell you are frustrated and your bag is really important. Lemme talk to the nurse and see if we can find it. What else do you need?”

“water.”

His cup was next to his bed, just out of his reach. I gave it to him. He started to soften.
Few minutes later, the inevitable news, “sir the staff can’t get your bag. I’m sorry. I can’t control that. You mentioned you were concerned about motion sickness for our flight, I can control giving you some medicine for that. Can I give you some?”

He turned the corner. He didn’t want me to leave his side. Why? Because he felt heard and felt like someone was doing things FOR him, not TO him. I still got the outcome I needed too, we got to the ICU.

Episode 74 discusses 10 lessons from an extraordinary Air Force PJ rescue. Lesson 10 is “remember who you are fighting for.” We are for patients, people just like us. We are fighting their circumstances, pathology, and system constraints. Don’t let the fight get personal. This patient was initially insulting and demeaning. I remembered it wasn’t about me. His fight isn’t with me, just like my fight isn’t with him. Be honest. Be respectful. Set a tone that respect begets respect.
Stay safe and don’t be abused but also remember, “It’s not about the bag.”

13/09/2024

A patient becoming unresponsive from anaphylaxis or asthma is a “seconds count” situation, where we can make a life saving difference, allow us to explain.

A patient who loses consciousness secondary to anaphylaxis or asthma is hypoxic. We must act quickly to prevent anoxic brain injury. Their hypoperfusion compounds on an already critical presentation. This is a situation for us to be aggressive with the right interventions to have a positive impact.

The AMAX4 algorithm is an effort to turn tragedy into learning. For more on the story please visit their website. In our episode 73 will discuss critical anaphylaxis and AMAX4 with Bruce Hoffman. Bruce is a senior educator with . We dive into the pathophysiology of these disease processes and why the AMAX 4 approach saves lives. Here is the gist and please remember this is for the most critically ill patients with anaphylaxis or asthma, usually when standard care is unsuccessful. You should ensure your protocol and/ or medical direction support this treatment:

A - Adrenaline
M - Muscle Relaxants
A - Airway
X - oXygenate, eXtreme, and Xtra
4 - 4 Minutes

Adrenaline. Epinephrine can be administered at a dose of 10-50mcg aliquots every thirty seconds, IV. Continue until you see improvement.

Muscle Relaxants - If your system carries paralytics, this can be a time to use them. At you normal dose.

Airway - A definitive endotracheal tube should be established quickly by the most experienced provider. A supraglottic airway will not be sufficient to overcome the airway pressures involved in this disease process. If endotracheal tube placement is unsuccessful, cricothyrotomy should be strongly considered.

oXygenate, eXtreme, & Xtra - Be eXtremely aggressive with your other treatments. Antihistamines, bronchodilators, steroids, vasopressors, and ventilations.

4 minutes - This should all be done in 4 minutes. When patients become unconscious in these situations they probably have a saturation of around 40%. Anoxic brain injury can start at 4 minutes without intervention.

For more on this, start with our episode!

10/09/2024

One of the worst calls taught me one of the best leadership lessons.

I responded to a driver hitting a crowd of children. The dispatch alone was alarming. One kid laid in the street motionless. Another sat on the sidewalk crying, obviously scared but ok.

We went to work. My partner was attending. He went to the patient in the street with our trainee third rider. I did a quick triage and determined we only had two kids struck and the kid on the sidewalk was barely injured. Bystanders pointed and yelled, “they went that way!” the car fled after it left the roadway causing chaos.

That’s when it happened. I felt a hand on my shoulder and someone firmly say my name. I turned to see my supervisor, who said confidently, “whata’ya got.”

“Two kids hit, that one’s walking wounded, this one’s gonna die. The driver is gone. Went that way.” I pointed to all involved.

“Good job. Go.” three words said with slow confidence. It instilled calm. Our trainee drove. My partner and I were in the back attending. Our scene time was short. We took a firefighter rider, who soon started compressions.

My supervisor wasn’t on the initial dispatch. Instead he responded decisively to ensure he was in the place where suffering was the heaviest. He didn’t bring judgment. He didn’t bring, judgement or attitude. He came to support those doing the hardest work. I felt loved. He purposefully inserted himself into the point of friction for me and my partners. He didn’t just support me with words, he did it with actions, and he later helped me get into therapy to deal with a stack of calls in my brain. This, being one of them.

EMS providers are hard people to lead. We work independently, and are looked too as leaders of chaos. Leading us means you are leading leaders. Not easy. Let your example shine. Be intentional with words. Support your people.

In Episode 72 we discuss with Geoff Murphy of how the actions of leaders can change safety and care.

03/09/2024

EMS can grow in this. A psychologically safe environment is one where teams thrive through learning from error, sharing lessons, and do not operative from a place of ego.

In episode 72 we talked to Geoff Murphy of . He discussed an experience in which an error lead to learning throughout his team. The error was not committed by him, but someone who he was responsible for training. He owned that error as his own, making his trainee feel safe and promoting learning amongst his coworkers. He drew from lessons learned in the book, The Fearless Organization by Amy Edmondson, a great read on the subject!

In our episode Ross also shared an experience of an error he had in the emergency department that nearly had catastrophic consequences. The outcome from sharing this experience with his peers will surprise you.

I was in a situation where I was leading a paramedic that had a lot more experience than me. It was intimidating. I wanted to build relationship with him and try to promote a healthy professionalism. Honestly, much of me wanted to go about my day and avoid him. He worked independently and did a great job. I approached him one day, swallowed my pride and asked him to show me some tips and tricks for our local response area. It was tough. His tone was somewhat, “you’re suppose to be in charge of me and you don’t know this stuff?!”

I took it on the chin, asked him questions. Engaged in what he wanted to show me, and most of all I learned things. Months later I was faced with a chance to give him an other paramedic feedback on how a call was executed. Guess what, he listened and respected my opinion. By humbling yourself and listening you feel like it’s projecting weakness. It’s the opposite, you show strength. People respect it and want to follow it. This can happen at all levels of EMS.

23/08/2024

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31/07/2024