Practical EMS: Recent Episodes
Practical EMS
Emergency medicine is a very difficult specialty with unique challenges, and it calls us all to be better than the average person in order to stay healthy for our patients, our families and own mental wellness. My mission is to serve Paramedics, EMT's and anyone that works in Emergency Medicine with content that is relevant and practical to their everyday roles. I want to connect with EMS crews, fire crews, ER RN's, ER techs and new ER advanced practice providers to better understand their current struggles. I also want to bridge the gap between prehospital medicine and the emergency department and to encourage those seeking to become an advanced practice provider. Disclaimer: All Practical EMS content is opinion only. It is unaffiliated with any company or organization and does not represent any company or organization that Aaron currently works for or has worked for in the past. No content should be taken as medical advice.
I give my perspective on being an APP in the ED, be humble and teachable and strike an affect that allows the physicians to speak into your practice
When in doubt, consult the specialist
Julie talks about what makes her proud about her career
She is proud of the connections she made, that she treated her patients how she would have wanted to be treated
Remember to take that intentional time with patients to help reassure and connect with them
Julie talks about a the expectation she sets for patients with abdominal pain - that we don’t find a clear answer most of the time and when we do it’s usually something emergent and surgical so sometimes no answer is good news
Set the right expectation for the ER visit early
She talks about how she reassures patients that may be embarrassed for coming in when they end up not having anything emergent going on
Julie highlights the need to eat and hydrate on shift
Julie talks about the next generation of providers and how she hopes they continue to keep their observation skills and clinical thinking skills intact considering technology advances and AI incorporation
Julies advice to her younger self would be to not let people drag you down
A big thing we need to learn is to not let others poor behavior or flexing of their ego affect us personally, it speaks more about them than us
We need to learn to give constructive criticism without judging
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Mindsets to avoid burnout – Julie humanizes the patient and understands that whatever difficult things we are dealing with are temporary and have gratitude
We must constantly recognize possible anchor bias and avoid cynicism to appropriately treat our patients
We talk about our interactions with EMS
Both Julie and I remember working in EMS and the value that EMS brings in their report because they often see a lot of things we don’t get from the history of the patient
Julies advice for the new APP/ER doc - don’t come to premature closure on a diagnosis, don’t be afraid to ask questions, pay off your loans over buying the biggest house and latest toys
We talk about the baseline level of stress we deal with
We talk about technological changes over time and imaging improvements
She talks about the challenges that the Covid pandemic presented and the shortages of different things we have now encountered
Julie still finds meaning in finding the hard differential diagnosis and working towards positive patient interactions, the teamwork in the ER
I talk about the importance of creating an approachable affect so everyone feels free to voice concerns
Go look at the patient when the nurse is concerned
Julie talks about the benefit for new EMT’s and paramedics to reach out and ask for feedback and follow up on their patients, often we don’t have time to pull them aside
EMS doesn’t have the best mechanisms in place for good feedback on every case like we do in the ER, where we see in real time how accurate our assessment may have been when the work up comes back
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Started out her medical career as an EKG tech and in EMS as an EMT for one of the first ambulance companies in the area
She saw the disconnect between the provider that people wanted to become and who they became, and she didn’t want that to be true for herself
She became an attending in 1991 and now has close to 40 years in emergency medicine
She became a physician when it was predominantly a male field
Julie talks about some of the things that have changed over time
We need to have empathy for the people that come in for non-emergent complaints and realize that we have the honor in the ED to fill all the gaps in the wider medical system
We talk about the increase in transparency with patients and the access they now have to their lab work, imaging and chart and this helps us increase trust with patients
Julie talks about a paramedic partner she really admired and how well she treated patients, and how there wasn’t a lot of female role models for her in med school
I talk about how I also had partners that really improved the trajectory I was on as a new EMT
Seek first to understand is one of the 7 habits of highly effective people and this relates directly to taking care of patients
Julie talks about how it was to be a woman in medicine and how her voice got dismissed as well as the dynamics that are at play with patients
Julie talks about burnout and how labyrinth therapy helped her. How you need something that helps you look beyond yourself to have a moment of awe and gratitude
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Brian talks about his experience being on the “other side” of the bedside with his wife’s cancer treatment
He really appreciated the extra time that the doctors spent with him and his wife to explain things – repetition is very helpful for your patients to really hear you
Brian talks about balancing fatherhood and being a husband with our emergency medicine schedules and the challenges of being in a physician couple
You have to figure out family priorities and what works well in your situation
Date night is the most important investment you can make
We talk about how to transition from ER mode to husband and father mode
Brian talks about how finishing his notes helps to make his mind move on or answer some questions he may have to resolve a conflict he might be having
We talk about church attendance as Christians
Brian tells a powerful story where he was able to save and prolong a patient life so he could talk with his family
“Sometimes it’s more important to help someone die than to help them live”
We need to be intentional about remembering the big and the small good things that happen throughout our day
You never know when you might be the last person to interact with someone and may make the difference between them, deciding to give the ER another chance
Brian talks about advice to his younger self – don’t work as hard, take more time off
Prayer will get you to the right answer, if you call yourself Christian you should be displaying the Christian examples we are given
You shouldn’t have to leave your faith at home, it’s your best ally at work
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
We talk about setting the right mindset, culture and tone as a leader of the department and especially in smaller facilities
You don’t have to be perfect, but you can avoid the little negative comments and criticisms
Being a good example goes a long way
As a Christian we are supposed to act like Christ would
We have a lot of metrics we have to worry about as clinicians but, as Christians, we need to worry about the metric of mercy
Understanding that we are not as far removed from the homeless, drug addicted patient as we might think
We have to remember that, as we care for the homeless and drug addicted person that no one else will care for, we are doing it for Jesus
Brian tells his students to spend as much time with the patient as they need, you don’t have to be the fastest provider right away
We have to be careful about bias getting passed on from triage and from EMS reports as well, sometimes the problem is more subtle and requires more time with the patient
How we word things when talking with patients makes a big difference
We talk about providing respect and dignity to those patients that die
Brian talks about some on-shift practices he uses to re-center himself on his purpose
We talk about the grey area in which we practice in the ED
I try to practice assuming good intent on others
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Has been an attending physician since 2019
Brian volunteered when he was a teenager in the ER and the staff that got him involved really drew him toward emergency medicine in med school
Brian worked in the ED as an EMT as well
He talks about early mentors and the impact they have, including helping him get loans for medical school
We need to remember to be like that mentor that encouraged us when we were new and pay it forward to the next generation of students
You must have something that drives you in emergency medicine, it is a difficult specialty. At first the dopamine drive from the excitement can carry you a ways but it will fade over time
Brian talks about how faith led him to where he is now
We talk about the fulfillment of just having good conversations with patients and making sure they feel cared for and understood
Brian talks about recognizing burnout, it’s a “general sense of not being whole” like something has been taken from you
He talks about the golden handcuffs of being a physician
Brian talks about how he overcomes exhaustion and burnout
Cold plunging - forces you to be in the moment, control you heart rate and breathing
Choosing hard things makes those hard things that are forced on you easier
Living in the moment is largely equated with happiness, the more you can do this the more you can be happy. Meditation and many other therapies are simply teaching you to keep your mind in the moment
A wandering mind is an unhappy mind
Prayer is another method for focusing your mind
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Advice for the new EMT, paramedic, nurse, physician who is also a believer
Build your faith in the easier times so your faith doesn’t shake when times are hard
You have more reason than anyone on the planet who doesn’t believe to strive to do this job better every day, you are held to a higher standard
Adam still finds joy in emergency medicine, doing hard things, interacting with many different humans, seeking an answer, the intellectual stimulation
You must be able to embrace the hard stuff, embrace the suck
Adam talks about the priority he gives to family and being mentally present when he is physically present with his kids
He talks about the training that is required to make yourself mentally present outside of work and how to move on from a hard shift
“He told me to cast my cares to him because he cares for me”
Take care of yourself before you take care of others
In our line of work sometimes quality is better than quantity time
Adam gives the advice he would give to his younger self
He knows himself well enough to know he should say “Stay scared my friend,” because he can take that in stride and not panic. This job can be out to get you
You don’t know what you don’t know
Don’t step over the line between confidence and cockiness
Adam talks about some practices he has that allow him to move from ER physician mode to father, husband mode
Praise and worship music on the way home helps him
I try to remember to keep my eyes above the waves, like the story of Peter when he walks towards Jesus on the water
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Faith and burnout
Adam talks about how he tends to spend his spare time reading the Bible, going to church, spending time in prayer and how this develops character and is better than pursuing time wasting activities or the easy dopamine dump that does not add to sustainability or self-improvement
We are designed to do hard things – mental or physical – including pursuing Jesus – this builds stamina, character and makes you better in your career
Choosing hard things makes the hard things that you don’t choose much easier to handle
Seeking hard, painful things can reset your own personal pain scale
We can find more reward and satisfaction in the suffering than the result, less satisfaction in being done
“Re-shift your mindset to find that the goal is the struggle and you are overcoming it”
Journey over destination
“The reward comes from striving, from the journey”
“That’s the example of Jesus”
We talk about the apostle Paul and his example
Social media skews our view of other humans; it polarizes us and makes us see the worst of humanity instead of seeing the good
There is some benefit to boredom
All sacred texts talk about the need to meditate on these things, allow yourself to sit in silence and seek what you are trying to find
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Former paramedic and has been an ER physician for 7-8 years
He pursued emergency medicine after his experience as a paramedic because he feels it is more in line with his personality
We talk about how emergency medicine checks a lot of exciting boxes that we enjoy
Adam talks about his burnout symptoms as well as how he course-corrects
He talks about symptoms like lacking as much compassion/empathy as he should have. So he corrects by talking with his wife, focuses on getting enough sleep etc
He has let go, to some degree, of all the “techniques” we learn to combat burnout and refocused on his “why” – he knows his purpose. He was called by God to do this job
“Without question, I was called to be in this position by God – it changes everything”
Part of the difficulty of the ER is the sheer volume of people we see on a given day, in a lot of ways, we are managing a lot of mental health conditions in that volume – it can be an opportunity and a gift rather than just viewing it as something to get through. Seeing people as human beings
This perspective can help us avoid cynicism – I’ve found that assuming good intentions on the part of everyone I encounter during the day goes a long way towards avoiding cynicism and taking better care of patients
We must intentionally hold on to the victories, the grateful patient, the lifesaving situation
When you look for the good, you tend to find it
We talk about setting tone for the rest of the staff in the ED
We talk faith in emergency medicine as Christians, it has everything to do with everything that we do in life and in the job
“I would have chosen an easier job with an easier route to get to it if it wasn’t for God”
“The hope I have in Jesus sustains me”
Why do awful things happen to good people
Free will leads to the world we see and proves that we are not God, yet we are called to His standard
The potential of every human to do self-seeking, evil is why we see some of the horrible things we see, the answer is where do we take these burdens
I discuss my view of free will and its ramifications and our mission on earth as Christians
“Should only bring patience and kindness and hope to an interaction with another human who is suffering”
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Give the escalating patients some room, you don’t have to be within arm’s reach
I talk about what a bad code blue looks like and what a good code blue looks like and how this translates to running a good code grey
Assign roles, we don’t have to surround every aggressive patient with a ton of people
Don’t join in the fight or flight mindset that the patient may be operating in
We talk about who should be lead in these situations and how we should be handling behavioral health emergencies when they escalate
We deal with staff and nurses leaving the field related to these negative interactions, so part of the goal needs to deal with the emotional toll it leaves on the healthcare individuals involved
Sometimes patients don’t choose the ideal plan that we may want for them, but we can’t let this burn us out and instead, focus on making a great alternate plan that will serve them
Josh shares a great personal story where he went above and beyond to help a grieving family member that still remembers him from a decade ago
Sometimes all we can do is plant a good seed and the harvest is much later
Great customer service is an important concept, respect and dignity, empathy and understanding
Fight to understand, not fight to win
We have to frequently check our bias, we can miss opportunities and even medical emergencies if we write off a patients behavior as just a behavioral issue
We cannot help others until we take care of ourselves
Hydrate, use the bathroom, eat while on shift
We are all at risk of developing cynicism from negative encounters, so we have to be intentional of seeing the good
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Josh has 20 years in Public Safety
Currently doing crisis prevention instruction
We often don’t get any education in med school or PA school in how to communicate well with patients or how to de-escalate their behavior
Code greys are the behavior health emergency response; someone has some concern that a patient is escalating to potentially violent behavior and a team will respond
Staff safety is priority
We are there to provide excellent medical care, if it’s safe to do so
We recommend calling code greys earlier to avoid worsening scenarios
Code grey assures staff safety then de-escalation of the patient
Recognizing when you need help with patient interaction from some other staff member is important
Typically, negative behavior is a result of an unmet need or want
Rationally detach
Give people options, this helps give them a measure of control when they feel out of control
Get consent to do a physical exam, taking that extra few seconds to explain what you’re doing and getting that quick permission goes a long way
We forget that we ignore many social norms in the ED, patients may not be used to this
Always introduce yourself
A huge component to de-escalation of patients with negative and violent behaviors is that, if not done properly, they are a primary source of burnout. They become a huge negative experience that it sticks with you, not to even speak of the potential for an injury. Avoiding these negative experiences at all costs will be key to thriving in emergency medicine
Josh talks about a severe ankle injury he sustained and how he found a way to keep helping people anyway. He talks about how he strived to get the struggling people back connected to community. He helped them re-establish trust in others so that they could accept help
We talk about the resources available for financially struggling patients
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Lucas gives his pitch for why it is still worth it to be a physician - it’s one of the best jobs in the world but you have to have the ability to adapt to change over time
Being a physician still allows you a rewarding, stable and consistent job. A comfortable lifestyle. Job portability
As a PA, this can be even better because you can switch between specialties
Our variable schedule in the ED has its cons but it has a lot of pros as well
We talk about things that we find rewarding in emergency medicine
Even the non-work-related rewards when we often do nothing at all but reassure our family, our friends is fulfilling
The cascade from relieving anxiety and saying “you are okay” is powerful
A brilliant ER mind said “Don’t just do something, stand there”
If you are well, aggressive medical interventions are more likely to harm you than help you
Take care of yourself, take care of your relationships, the lone wolves die, humans need other humans to survive
In your journey in a career that is very difficult and very easy to burnout, the rewards are much more magnified on the other side. The rewards are much more in your control than you think. With the right mindset you can change how rewarding your career will be
This is an amazing setting, you have one of the coolest jobs in the whole world
What other job is there where you see people on the worst day of their lives, save a life and can allow other people’s lives to touch you
There is an honor to be there on someone’s worst day
Intentionally look for the positive, it is there
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Longevity in a tough field is something you need to consider as well as the right mindsets that keep you there – be intentional about being grateful
Lucas gives some advice in doing triage shifts and focusing on the good people you have the privilege to interact with and trying to be intentional about not focusing on the mean, angry patient
Intentionality behind the things that improve your well-being are more important to prioritize than you might think
Allow your family, significant other to help you
Fatherhood and dual income houses are more the norm now so both parents have to work toward raising children and working
Lucas gives advice to the new ER physician
The busier you are, the more stressed you are, the more you need to maintain hobbies
The PA profession has done a good job of setting people up for success with having a good work and life balance
Community is super important to cultivate, the lone wolf dies
It can be easy to justify allowing relationships to wane when you are busy in medicine and education, but this cannot be put off forever
Break the pattern of pushing off community in favor of career
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
ER physician for 15 years
He talks about this path into med school and emergency medicine as his first choice
He likes the challenge, lack of predictability and wide scope of problems we must solve. We have the honor to accept patients when no one else will
Lucas talks about how the term emergency medicine is almost becoming antiquated when we are doing acute, undifferentiated care
Some of the care is emergencies, but not all. And that’s probably for the best so we don’t get burned out
He talks about burnout and how we should focus on how to manage it when it happens as opposed to how to prevent it all the time
You need to accept that burnout will happen, so you don’t have an expectation mismatch
Being aware of your own burnout is key to correcting it
Optimizing the other things in your life outside of work like exercise, nutrition, community is key
Be intentional about focusing on the enriching case, appreciative patient, positive conversation you have throughout the day. If you look for the positive you will find it and then do whatever you need to do to get it in your long-term memory
Lucas talks about gratitude and how this requires intentionality as well
We talk about how much to share with spouses
We talk about the role of the clinician in the ED and how we have a lot of things to manage that other staff may not see
We talk about how to manage our limited resources
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Leave work on time
•David’s story: a skilled, compassionate paramedic who deeply connected with patients, especially during psychiatric crises.
oStruggled to separate work from life.
oRelied on alcohol as a coping mechanism, which ultimately cost him his life.
•Core lesson: In emergency medicine, you must leave work at work—emotionally and physically—otherwise burnout and unhealthy coping are inevitable.
•Healthy separation:
oBalance connection with patients while avoiding over-identification.
oRemember: “It is not your emergency.”
•Practical strategies to get off on time:
oCheck labs/imaging in real time.
oComplete charting as you go.
oPlan handoffs 1–2 hours before end of shift.
oControl what’s controllable—systems, shift crossover, advocate for better staffing.
•Mental discipline:
oSet down burdens from tragic or unjust cases (e.g., drunk drivers, preventable deaths).
oFind something greater than yourself (faith, higher power, or another anchor) to release what you can’t control.
•Work–life balance:
oCreate a clear line between work and home (physical transition, dedicated space, or ritual).
oAccept that some seasons demand more grind, but don’t let it become a lifestyle.
oYour family will notice the time you miss more than your employer ever will.
•Identity check:
oYou are not your job title; resilience and character matter more.
oOver-identifying with work justifies staying late and sacrificing home life.
•Universal takeaway: No matter the field, burdens from work will bleed into family life unless you intentionally lay them down. Getting off on time = preserving resilience, family, and long-term health.
Chapter 3: Take Care of Yourself Before You Take Care of Others
•Past struggles:
oPrioritized school and work over health.
oPoor sleep, binge eating, energy drinks, inconsistent workouts.
oLack of discipline → foggy brain, poor performance as a paramedic.
•Core principle:
oYou cannot care for others well if you neglect yourself.
oIn EMS/ED, emergencies are unpredictable, but most patients are not crashing—there’s time to hydrate, eat, and reset.
•Practical applications:
oDrink water, eat proper nutrition, and rest before/during shifts.
oPrioritize morning routines (hydration, exercise, food) → sets the tone for the day.
oMeal prep to avoid cafeteria junk food and impulsive choices.
oCreate habits that are accessible (water bottles, packed meals).
•Mindset shift:
oCaring for yourself
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Introduction
- My first experience with a cardiac arrest as a new EMT → exhilarating, confirmed calling to emergency medicine.
- Early struggles: dropped out of college, lacked discipline, but EMT training provided a direction and purpose.
- Spent years balancing work as EMT/paramedic with school → long path to becoming a PA.
- Lessons from emergency medicine shaped clinical skills and mindset.
- Concept of standards:
- Standards = benchmarks, measurable expectations, non-negotiable habits.
- Different from principles (general truths) → standards are concrete, either met or not.
- Standards build consistency, resilience, and preparation.
- Personal struggles: binge eating, lack of discipline, repeated failures to meet daily goals.
- Turning point: completing 75 Hard program → developed discipline, consistency, higher personal standards.
- Standards spill over into clinical performance, family life, and personal growth.
- Emphasizes locus of control:
- Focus on what you can control, not external factors.
- Even in chaotic emergency medicine, there are controllable elements.
- Warns that neglected habits eventually become emergent problems (health, mindset, life).
- Family story: father’s heart attack → personal wake-up call about health and discipline.
- Core message: Raising standards in personal life and medicine leads to thriving, not just surviving.
- Purpose: help others raise their own standards without taking 16 years to learn the lessons.
Chapter 1: Do Not Seek to Diagnose
- Case study: elderly woman with shortness of breath and chest pain.
- No pulmonary embolism, but fluid in lungs and around heart → problem found, but no definitive diagnosis yet.
- Highlight: in the ED, the goal is to rule out life-threatening conditions, not always find the exact cause.
- Key principle: Diagnosis is often less important than identifying and stabilizing dangerous conditions.
- Emergency medicine limits:
- Not every test or long-term treatment available.
- Focus on acute, life-threatening issues; leave underlying cause to specialists.
- Patients often expect answers and certainty, but ED care is about safety and ruling out the worst cases.
- Overdiagnosis problems:
- Incidental findings (lung nodules, brain aneurysms, ultrasound anomalies) → create stress, anxiety, or unnecessary proce
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Advice for new EKG techs:
Trust your knowledge and build your confidence over time, stay calm and take deep breaths when you start to get busy
Stay humble, ask for help
No one comes out of school knowing everything, you need to know your limits
Regardless of your role, don’t be afraid to advocate for the patient
Providers need to remember to project an approachable demeaner so that everyone has a level of comfort bringing things to their attention
It’s important to take your job seriously and do it to the best of your ability
Cheyenne talks about the stress of scribing
Sean talks about some frustrations he has with nursing putting in frequent EKG orders without the right indication
We talk about some of the specialties within cardiology
If you are looking into getting into medicine, look at EMT or EKG tech. They both give you a great insight into the greater medicine world
There are a lot of great jobs that introduce you to medicine before you take the risk of PA school or medical school
Sometimes the only way to really understand what you are getting into is to get into the field instead of reading about it or watching videos about it
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
We talk about stat vs routine EKG orders as well as metrics that they are always working to hit on time
When EKG’s are not done on time the source of the problem needs to be found, sometimes it is the providers’ fault for not realizing the EKG order had not been placed
We talk about how we should communicate between provider and EKG tech and how much info we like to get as providers
I talk about how providers need to become good at task switching frequently and this includes signing EKG’s
We talk about the responsibility of the PA or NP to sign EKG’s (calling STEMI’s or deciding not a STEMI) and how this responsibility is currently in the hands of the physicians only
Sean talks about how important EKG’s can still fall through the cracks at times and people will still point the blame all the way back to the EKG tech
It’s important to make sure you do your job well and then realize some things are out of your hands
Cheyenne talks about an experience she had with an end-of-life patient she cared for
Even being just peripherally involved in a patient’s care can really affect you emotionally
Avoiding burnout:
Cheyenne likes to go to the gym or hang out at home with her dogs
Sean talks about how he avoids burnout doing a job that can sometimes be repetitive
Sean also talks about the importance of calmness in front of patients, even when an EKG might be alarming
Don’t sweat the small things, especially in the ED, everyone is under a lot of stress, and you can’t allow a small comment from a stressed-out coworker to get under your skin and make you spiral
Sean talks about some methods to reassure patients despite not being able to diagnose their EKG
We talk about the importance of stress management in the ED so that you can think clearly about the next patient
It is not your emergency, we must be the calm in the storm
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Welcome to the show Sean and Cheyenne, EKG tech experience and scribe experience
Sean talks about certifications and expectations that go beyond merely obtaining an EKG as well as the stress testing role
Cheyenne talks about the role that scribes play in the ED
Scribing for providers is often used as a role to gain patient experience for medical school or PA school
They talk about how they got into scribing and EKG technician work and Sean talks about how it is also a role that is used as a steppingstone
12 leads are complicated to interpret and require a lot of training and experience to get good at. They are even harder to interpret when the patient is not in front of you
STEMI’s are the key EKG’s to recognize because they are so time sensitive, but we don’t see these frequently – it can be very helpful when the tech recognizes this and can recognize the urgency
Knowing early signs of impending problems on the 12 lead can be helpful for patient prioritization as well
Being an EKG tech requires good resource utilization, sometimes there are not a ton of EKG techs available in the hospital, so they need to prioritize – communication is key
Communication between roles is so important when we are trying to get quickly get imaging, labs, assessments and EKG simultaneously
At the end of the day, the patient is the top priority
Scribes do deal with a lot of stress, they must finish notes, write new notes and keep up with high volume, they like active communication with the provider
Sean talks about how a typical day can vary quite a bit
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
I’d like to welcome to the show Dr. David M. Berry, MD, he is a growing voice in the recovery and addiction space, an area that we deal with a ton across EMS and the emergency departments. He is an Emergency Medicine physician with over two decades of experience.
You can reach him at dberrymd@hotmail.com
Burnout and moral injury – how do we avoid these in dealing with the addicted and psychiatric patients? We can’t control most factors involving their long term care but David says: “give these folks the best care I know how to give them.” We can control what WE do
We talk about the best way to communicate between providers when passing on patients to the next shift
Dr. Berry talks about a patient he advocated for that he felt needed in-patient psychiatric admission but had been initially turned down
He talks about the importance of working patients up appropriately and not ignoring patient complaints, getting the emotion out of it
What would you do objectively if the patient was not a frequent flyer?
Dr. Berry talks about a substance use clinic he helped open in Western Colorado
He talks about meth addiction and how recovery works in his clinic
He tells a story about the devastating effects of meth on a young patient
The danger of meth is not in the withdrawal but the effects of it on your body
Dr. Berry talks about the limbic system, the reptilian part of our brain. People who struggle with addiction have a missed connection. Normally, when the average person drinks, a message gets relayed back from the brain saying slow down, you have responsibilities, you have work, you have a family. The addict’s brain doesn’t send this message back, they just get the message to drink more cause it feels good. This applies to any addiction
Their decider is broken, that’s why they need a sponsor, and their brain can eventually rewire and make the needed connections
The anatomy problem of missed or failing brain neurons is what is going wrong in the addict’s brain
This helps us understand where the blame truly needs to be placed, not on the addict for poor moral character or poor self-control but on a brain that isn’t wired correctly
Winston Churchill said everyone has an addiction, the key is finding one that is socially acceptable
Dr. Berry talks about Recovered on Purpose, an organizat
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
I’d like to welcome to the show Dr. David M. Berry, MD, he is a growing voice in the recovery and addiction space, an area that we deal with a ton across EMS and the emergency departments. He is an Emergency Medicine physician with over two decades of experience.
You can reach him at dberrymd@hotmail.com
We must remember, when working up these patients with addiction, they can have poor health baseline anyway, so they are at higher risk for something emergent to be going on
Dr. Berry talks about this approach to opiate OD
We have a small window between the ED and definitive care to help addicted patients move forward with treatment – a warm handoff to a treatment center or primary care that can monitor recovery is key
We have specific rules for most emergencies but often psychiatry is not on a set system
Holds may not always accomplish what we hope they will, it will not force someone to change
But there is certainly a role for the patient who is genuinely suicidal
We talk about good structure of evaluation and treatment of the psychiatric emergencies
David talks about some patients he has been able to help with addiction recovery from his experience
Don’t underestimate the difference we can and do make with patients just because we don’t always see the result
Dr. Berry talks about the message he has for clinicians:
We deal with a lot of emergencies, people actively dying, so when we hear a psych complaint or substance abuse complaint, we tend to mentally shuffle them into a lower priority. We need to remember to have empathy and take their complaints seriously, slow down with these patients
We talk about the balance between empathy and detachment and burnout
David talks about some methods of humanizing the experience for your patients and getting them to open up more
We talk about anchor bias and how to protect from it
David talks about conformation bias and how it relates in piloting an aircraft and emergency medicine
A key question to ask before you leave a patient room is “Do you have any questions?” – This can be hard to ask because we often want to move on but it’s so important to the patient
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
I’d like to welcome to the show Dr. David M. Berry, MD, he is a growing voice in the recovery and addiction space, an area that we deal with a ton across EMS and the emergency departments. He is an Emergency Medicine physician with over two decades of experience.
You can reach him at dberrymd@hotmail.com
He has an incredible story. He was conceived following a one-night stand and was almost aborted before being put up for adoption to a loving family.
He had his first child and felt the gift of knowing his first genetically related family member for the first time.
Tragically, his first daughter was diagnosed with spinal muscular atrophy, a diagnosis not compatible with life and she later died around 9 months of age.
This led David to turn to alcohol to help deal with the pain. His family took notice of this, so he transitioned to opiates instead of alcohol, something that he could hide more easily.
He was eventually found out and spent some time in jail and tried some treatment centers. He lost his medical license, his family left him and he became homeless.
His rock bottom was when he found himself homeless living under a bridge with no ID and realized that no one would even realize if he had died.
With the help of another doctor, David started taking Suboxone, which helped him to overcome opiate addiction.
This opened a path to Dr. Berry getting his medical license back and eventually led to a role as chief of staff of his hospital as well as opening up a rehab clinic in Colorado.
Hearing David’s story helps put in perspective the fact that none of us are that far removed from the homeless, drug addicted patient we care for in the ER.
He talks about his new appreciation for his life and his family
We talk about techniques to get patients to open up to us despite our short time with them:
“Do you mind if I examine you?” gives the patient some control in the situation
Some of our biggest misconceptions about these addicted patients is “They are trying to game the system,” maybe they are, but maybe they are totally out of options or are having a real emergency.
“What can I do to help you?” may open up a conversation about what they feel they need
Small, short conversations can make a big difference over time
We often don’t have enough time with patients to label them with anxiety disorder or opiate use dis
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Creator of the philosophy The Art of Bending Time
You can find her work at Michelleniemeyer.com, LinkedIn and can text CLARITY to 33777 to get support
Michelle talks about what moved her away from law to helping others improve their lives
Finding fulfillment outside of work hours to pursue something that is important to you can have beneficial effects on your work hours
Work life balance is bullshit
Sometimes building community and social interactions while at work is an important step to building a strong team. Telling your family and friends outside of work about your work life can be equally important. They don’t have to be totally separate parts of you
In the end, we are whole people
Personally, it is easy for me to isolate at work, but I feel better when I make the intentional time to get to know my coworkers
Remember your spouse is a partner in life with you, invite them into your work struggles
Take care of your body and your mind to avoid burnout
Be clear who you are
TEXT CLARITY to 33777 to get access to a free community page with Michelle’s guided meditation program to help you get clarity on life and remember what bring you passion and fulfilment in life
Creating a roadmap in life is crucial to making the life you want happen
Sometimes very difficult things are obtainable, but you have to take one step at a time
Michelle speaks to some healthy habits she has daily to start her day the right way, like taking her dog for a walk
Habits of unwinding at the end of the day are key as well, put down the phone well before bed
Leave for work with some extra time built in so you don’t get frustrated by traffic, start your day on a positive note
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Creator of the philosophy The Art of Bending Time
You can find her work at Michelleniemeyer.com, LinkedIn and can text CLARITY to 33777 to get support
Michelle talks about a turning point in her life where she ended up in the ER and how this changed her perspective on health and nutrition after she was later diagnosed with PBC
Is burnout in our control?
Michelle says that the things that cause burnout are not in our control, but you can impact how you respond and how you look at the world
She recommends focusing on the things that you enjoy in your day, meditating on them
Michelle talks about some of the struggles she had as a lawyer and how it was difficult to not see the benefit of her work for 8 months to a year sometimes
Learn to be in the moment, if you are thinking about the future all the time you will suffer anxiety and if you are thinking about the past, you will be depressed
Setting goals is important, you need to be working towards something in life and figure out an action plan to accomplish them
Make sure they are goals that YOU want, as opposed to something that someone else wants for you
Delegate certain tasks, ask for help, don’t always micromanage
Step back and allow others to learn and grow
Michelle talks about how shifting from running all the time to enjoying walks outside improved her health and prevented injury
She talks about the importance of getting enough sleep and movement
Nutrition can be medicine
Michelle talks about a big case she was working on and how some dedicated, focused time, away from distractions, with adequate rest and movement, helped her through
Take care of yourself before you take care of patients
To get focused work done, you need to set up your environment correctly and remove distractions
One distraction can make you lose precious focus one a given task
Multitasking is a myth
Burnout happens when people don’t feel any meaning in what they’re doing
Sometimes switching jobs or careers will not solve burnout, but establishing some good habits can recreate the fulfillment in your current job again
You don’t see the light when you stay doing the same stuff
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Dr. Emma Jones is a hospice and palliative care physician, also worked as a pediatric oncologist and pediatrician. She’s been in the field for over 10 years and is active in helping healthcare professionals with burnout in the modern medical system. She is the author of The Phoenix Blueprint, Emerging Stronger from the Blaze of Healthcare
https://www.emmajonesmd.com
Boundaries are important to set up in your work. Proper emotional boundaries with your patients are important to maintain your separation from another person
You can see another person’s emotions, recognize them and understand that they are not your emotions
True empathy does not improve your ability to provide patient care
Recognize when you do take on another person’s burden so you can do the work to set it down
We have to always remember to be patient centered. When you express empathy or share a personal experience with someone it should be serving a clinical purpose. It should never be done to help you process something
Is the patient benefiting from you relating to their experience?
Would you be better off to discuss your experience with a therapist or family member?
Spending more time to reassure and answer patient questions will save time in the long run and allows you to fully address the chief concern over the chief complaint
Rapport is developed not with time but can be done instantly by simply being a human being
Unconditional positive regard is viewing the patient or coworker or whoever you are interacting with in a positive light
This allows you to interact better with the patients you see, viewing the problem as the enemy and not each other
Positive attitudes, smiling and friendly behavior can be culturally discouraged in medicine and this needs to change, of course some situations call for a reserved attitude, but many do not
Giving away happiness and positivity does not take something away from you, it actually gives you more joy
We talk about mentoring and teaching the next generation of medical professionals
Advocacy for policy change is one of the last chapters of the book because you really have to overcome burnout in order to have the energy and motivation to take those steps
You must restore yourself to help make changes to the system
We talk about the pit fall of perfectionism. Perfectionism is different than excellence
Perfectionism is a habit that does not serve
Perfectionism is when you try to bring things from the circle of concern into your circle of control - it doesn’t work
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Dr. Emma Jones is a hospice and palliative care physician, also worked as a pediatric oncologist and pediatrician. She’s been in the field for over 10 years and is active in helping healthcare professionals with burnout in the modern medical system. She is the author of The Phoenix Blueprint, Emerging Stronger from the Blaze of Healthcare
https://www.emmajonesmd.com
Sometimes you need to realize you may be part of someone else’s plan and get onto your own plan
Dr. Jones talks about the difficulties with working with pediatrics but also the amazing resiliency of kids and their parents
We are told that medicine is a calling and a privilege, and we should sacrifice everything in service of the patient – this is an unrealistic expectation
We talk about burnout and moral injury
Burnout a helpful term because it’s something we can all feel and understand and use to seek help
Moral distress or injury is something that occurs regularly - when there is discordance between what you want to do and what you are able to do - whereas burnout is more at the end of a line of moral injuries
Burnout triad: emotional exhaustion, cynicism, lack of fulfillment
If we can get the frontline healthcare workers out of burnout and the day-to-day strife, we can help them be part of the solutions to the problems we face
Dr. Jones talks about the philosophy of yoga and how it can help us flourish
Sleep is vital to healing from burnout. It allows the brain to clean itself; you are smarter after getting adequate sleep
A lot of us are not even giving ourselves the opportunity to get enough sleep
Lack of sleep makes it difficult to put things in their proper context and map solutions
We talk about core values and the importance of knowing what yours are and how they correspond to your actions
Emma shows the actions she takes to correspond with her core values
Joy and humor are a huge part of our humanity
Questioning your thoughts is key. All thoughts are lies. We recreate memories. Our memories are fallible and tend to degenerate the more we recall an event
Learn to let go of thoughts that do not serve you. Choose the ones that are helpful. You get to control them. You cannot believe every thought that comes into your head
Steven Covey describes 3 types of circles in our lives in The Seven Habits of Highly Effective People. You have the circle of control you have direct control over but the circle of influence and circle of concern you have less control over. The point is to recognize what is worth focusing on and what is not worth your focus. For exampl
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Bryan Jepson MD and CFP, author of The Physician's Path to True Wealth: 12 steps to gaining control over your money and your time – you can find it on Amazon and at this website for free Bryan Jepson MD, CFP® | physician finance
Disclaimers:
This is not specific financial advice, this is general education. Talk with your own advisor or schedule with Bryan to get specific advice
The easiest, most straightforward way to start creating assets is to invest in your 401k
Debt to fund a liability is bad debt, it takes money out of your pocket
Debt that leads to more money in your pocket is good debt, but this requires wisdom in choosing your degree and education path
There are a couple of methodologies to pay off debt, the snowball method vs the avalanche method. Snowball goes smallest debt to largest. Avalanche goes from highest interest to lowest interest. Use the one that will actually work for YOU and will make you be consistent
The 4% rule: generally, when you can live off 4% of your investments per year, you have enough for retirement
So, if you need 100K to live off in retirement, you need 2.5 million in investments
Why does everyone need a will? If you have kids, it allows you to designate a guardian should you die. It also allows you to allocate where your assets go
What is the importance of giving away money?
Giving can be looked at through a couple different lenes. When you give, you are blessed in return. Or maybe you can view it as good karma
Bryan talks about how relationships are an important aspect of life and giving allows for meaningful relationships with something you value. Donate money but also your time
When you are rich, you don’t have the cushion to give. When you are wealthy, you have the ability to give to others
Finance is simple but not easy because you need discipline. You don’t have to get far into the weeds to be successful
Bryans book has the foundation you need to understand finance
Bryan talks about the difference between a financial advisor and a certified financial planner
Bryan gives his opinion on whole life insurance vs term insurance
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Bryan Jepson MD and CFP, author of The Physician's Path to True Wealth: 12 steps to gaining control over your money and your time – you can find it on Amazon and at this website for free Bryan Jepson MD, CFP® | physician finance
Disclaimers:
This is not specific financial advice, this is general education. Talk with your own advisor or schedule with Bryan to get specific advice
The earlier you can get financially literate and work on a plan the better
Bryan is an emergency medicine physician, along his journey in medicine he also spent 5 years working in Autism before coming back to EM full time
The covid pandemic and a feeling of stagnation and desire to keep learning prompted Bryan to pursue a master’s degree in finance
Bryan finds familiarity in his role as a physician to his role as a financial planner. You listen to the client and come up with a plan that fits their needs
Bryan talks about the difference between riches and wealth; discretionary income is the income above your mandatory expenses – and what you do with that extra income is how you become wealthy or rich
Riches are the material things you may spend that money on, car, house, toys
Wealth is the money you could spend but instead save or invest instead
The goal is to create assets so that your income is no longer needed. Buying back your time
When you have true wealth, you can make decisions with your time
Working towards being financially independent prevents burnout
Choosing to work vs working because you have to is easier, and makes you a better provider
Key attributes to develop to be financially successful: Be patient – assets grow slowly. Be consistent in investing. It is boring. Be honest with what you know and what you don’t know so you can spend some time educating yourself. Courage, because it does take some risk taking to invest instead of just saving
If you keep all your money in cash, you are guaranteed to lose purchasing power
The longer your time frame the better the stock market will perform for you
Creating discretionary income is difficult at lower incomes levels. But I do still believe you can retire from EMS. One way that I was able to save and invest as a paramedic was working overtime
Having higher incomes does speed things along but it is not the cure for financial problems because we all have a tendency to spend what we make – fundamentally it’s the same problem
We talk about the vehicles we drive and how we have utilized them to save more money
But spend money on
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
We need to remember that paramedic and EMT’s are solely focused on emergency medicine vs RN’s or even PA’s who are trained in general medicine then learn how to do EM later on
Learning sick vs not sick is a skill that develops with time, it’s not always easy
Gestalt can be an important factor in your assessment but don’t trust it all the time, it can lead you astray
A negative work-up does not always mean there isn’t something dangerous going on
Recognizing your biases will help protect you from making a mistake or overlooking something
Advice for the newbies:
Have humility when you are new, be willing to be taught
Never stop learning
Be proud when you do perform well
Don’t trust your gestalt when you are new. Take every patient seriously
Keep a journal
Be honest, do what you document and document what you do, admit your mistakes quickly
Taking ownership over mistakes helps you learn and gives you more respect than passing the buck
The call you are going to is the call you are supposed to go to. That is where you are meant to go. No patient is a waste of time. That patient deserves your undivided attention
Too many people hear the other exciting calls dropping nearby and they become distracted from what they are currently doing
People are put in your path for a reason
Alex talks about a night he ran 3 GSW’s and had to use good coping skills to recover
Sometimes the lower acuity patients can rejuvenate you
Running only high acuity will burn you out too, take some joy in the less stressful calls
Appreciate the highs and lows
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
How do we have long careers and avoid burnout?
Micah talks about burnout and how we have the advantage in emergency medicine that we can leave work at work and step back
Have time off and don’t work overtime every time an opportunity arises, don’t only discuss work with your spouse, have other interests that you can engage in
Emergency medicine is a fun job to identify with because we get to save lives, but you should not make it your whole personality
Find an identity outside of work, you may not have work at some point and life changes
Audrianna talks about taking care of yourself. As we spend so much time being empathetic for others, we can lose that empathy for family or even ourselves
We talk about the lower acuity patients we care for and infrastructure to take care of their complaint quickly from the ED, patients have poor access to primary care, and we can be that solution
We can’t use low acuity calls as something that burns us out or allows us to get frustrated, it will always be part of the job and we should view it as us being the solution
We can be educators, we are trained to recognize emergencies, the layperson shouldn’t be expected to know this
We have the privilege of taking care of everyone regardless of complaint, ability to pay, social status
Burnout begets burnout
Take the time off when you need it, overtime takes more from you than it may be worth
Certain seasons of life may necessitate working more but you have to understand the cost benefit
Just making it through COVID is a victory, it burned a lot of providers out, even those with experience
We recount some of our COVID war stories
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
How do we handle the sensitive hand-off reports from EMS to the ED?
Different aspects, like potentially violent family members, unsafe scenes, are often a critical details that need to be conveyed to the ED but don’t have to be announced to everyone in the hand-off report in front of the patient
Micah works as a field and ER paramedic. He talks about this situation and how it’s going for him. He enjoys the number of resources he has access to in the ED
Being able to see the whole workup and outcome of the patient is a big benefit as well, working in the ED
I love it when the EMS crews come back and follow up on their patients, it’s a big way to help them improve and learn
We talk about interpersonal conflict on scenes
Casey tries to be as friendly as he can and learn everyone’s names
It’s easy for all of us to allow our egos to get too out of hand, but we need to treat everyone how we would want to be treated
I talk about some issues I’ve had with the fire department in the past – sometimes it is all about how you are doing something as opposed to what you are doing in your interactions with other agencies
At the end of the day, the patient can be affected when we have confrontational scenes so we should always be seeking to avoid this
Alex talks about working 48 hours with his fire crew and responding on scenes with the same crew and how this differs from private ambulance responding with other agencies he may not know very well
Casey talks about how, years ago, the EMS crews had more time to stop by the fire stations and become more familiar with the fire crews
Casey talks about the power of edifying others in our field
Audrianna talks about a fire crew going above and beyond in the ED as well
We talk about small things we can all do to go above and beyond our regular tasks, helping families navigate the ED, getting a blanket for someone, cleaning a room
Little things like this also help you feel better about your job too; they help you remember why you got into medicine in the first place
It does require you to look beyond yourself to see those opportunities
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
New panel with Audrianna (RN), Alex (paramedic), Casey (paramedic) and Micah (paramedic)
What do the ER nurses like to get in the hand-off report from EMS?
Audrianna likes to hear clear, concise reports. How ambulatory was the patient on scene?
Casey recalls from years ago how the ER nurses didn’t understand enough about what EMS did, that always made giving reports more difficult and how that has improved over the years
I always try and give new EMT’s the freedom to struggle through giving reports so they can practice and improve without cutting them off or making them feel rushed
Giving report is a difficult aspect of the job, especially when it’s a critical trauma patient and you are giving report to a room full of people
It’s easy to get in a rush to move the patient over, but we need to give EMS the time to give report - It’s a big part of our day that allows us to build the team rapport between EMS and the ED
Alex talks about the perspective going from a busy private ambulance to a slower county system
We talk about differences in nurse workload vs paramedic in the field
Sometimes EMS doesn’t fully understand some of the nuances of how and what we use their IV’s for in the ED
Audrianna talks about how ER nurses are trying to maximize their time while getting report from EMS
ED charting is a lot more complicated than the field
I talk about how seeing ambulances when they arrive should be the highest priority for a provider
Micah talks about the limits of our ability to obtain accurate information in the field many times
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Some ambulance crews may not have the best understanding of how a fire crew is going to run a call, with everyone assigned specific roles – often the fire department will be allowing a new crew member to lead the call
I always struggled with arriving first on scene on the ambulance because that role is more work and more pressure
What does fire like from the ambulance crews when they arrive first?
First on scene should be allowed to lead the call and ask for help where needed, second on scene should not be pushing their way in and trying to take over the call
Sometimes the providers that take over lack experience or are not yet comfortable enough with their own skills to allow someone else to lead
If you have another provider on scene constantly trying to interrupt, give them something to do - often this applies to a disruptive family member
Does the ambulance paramedic have to attend in the back if the fire paramedic rides in?
As a previous ambulance paramedic, I viewed the ambulance as my space, meaning I always appreciated it when the fire paramedic had the respect to treat it as such, asking to ride into the hospital as opposed to telling me they were riding in.
As a general rule, if the fire paramedic believes they need to ride in due to acuity, the ambulance paramedic should also attend
Kash, as a medical director, gives his opinion on this situation
I really appreciated it when the fire crews respected our ambulance because the front is truly our office
EMT’s can ride in too on low acuity where more hands, not ALS treatment, is needed
I’ve talked before that a paradigm shift is needed for the paramedics at times, where they are more likely to have to attend more calls then their EMT partners - easy for me to say from outside the field now – but transporting the patient is almost always the safest, lowest liability option, we shouldn’t be trying to get out of transports just because it’s less work
Always treat the patient like they are a family member
We are looking for proof that the patient is not sick, as opposed to assuming they are not sick from the outset, our approach is different in emergency medicine
We have, historically, reversed hypoglycemia or opiate OD, and the patient has refused when maybe transport to the hospital is warranted despite the fact that we have temporarily fixed a major problem
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
How do we have successful, long careers in EMS?
John recommends living away from where you work, doing unrelated activities outside of work so your life doesn’t revolve around work things
Taking care of someone you know is an odd position to be in, it can mess with your ability to be objective
Jason says we need to have an awareness of how we are feeling and how those around us are feeling, therapy is always a great option, get outside
Those of us in EMS/fire do deal with a level of PTSD
Terry talks about this in his own life, when he broke down and started crying without an obvious reason
PTSD is not a lack of desire to cope nor is it a sign of weakness
Kash talks about burnout vs moral injury
Burnout tends to blame the individual vs moral injury blames the system we work in
I don’t disagree that the systems we work in are imperfect and moral injury exists, but I still like the term burnout because, no one is coming to save us, the responsibility is on the individual to overcome
Burnout can slowly occur to the degree that you don’t even realize right away what is happening
Is burnout inevitable?
Kash says that moral injury is inevitable in some form or another - the important thing is to recognize it and deciding what to do about it, take action
Acute vs chronic burnout requires different solutions as well
Kash recounts the Covid effects on EMS
Terry talks about the ability to acknowledge your struggles and continue to move on and live your life, in spite of them
I asked Jason about his decision to stay a fire paramedic instead of promoting up the chain, he didn’t want to promote just for the money, he would rather have passion for it. He is still very passionate about practicing medicine as a paramedic and enjoys his career as it is
How do we get along on scene when responding with multiple agencies, fire vs private ambulance
Jason talks about how beneficial it has been to see both sides, you can have more compassion for the other side when you see their struggles
Have the right attitude approaching a scene, work to get along with others as best you can despite the strong personalities we all tend to have
Sometimes a short conversation goes a long way. Having ambulance crews stop by the fire station for some food or short hang-out can also dramatically improve your relationship
We tend to assign ill-intent when we don’t know someone, vs good intent when we do know them
It is difficult to fully understand each other’s roles, when you aren’t doing that job on a daily basis, trauma bonding calls can be helpful when you get into th
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Our system has made access to EMS trained medical directors much easier, which is a huge benefit to the crews
The EMS fellowship for MD’s tends to attract those that are interested in helping EMS because they are passionate about it and not in it for the money
We are always trying to give EMS the amount of time they deserve when giving reports from the ER side
Kash talks about his technique in getting a good report from EMS on the higher acuity side
Every provider has slightly different preferences on how much information they like to get from EMS, Kash talks about his ideal EMS report
I really like the crews to lead with the chief complaint so I can understand how pertinent the rest of the report is
We talked about the previous culture on contacting medical control and how this has changed over time
What does retirement from EMS/fire look like?
Terry’s retirement came suddenly after an injury, which made it difficult as he wasn’t expecting it
Terry still remembers the calls he has run around town, the intersections, he says the bad memories have tended to get better over time.
He recommends finding something else to do in retirement, keeping busy. Don’t get stuck in the past recounting call after call. It can be difficult to give up the comradery you have at the fire department
We talk about the terrible question “What is the worst thing you’ve ever seen?” that we frequently get
It forces us to recount those horrific calls
The person asking the question is not mentally prepared to hear the answer
I talk about the difference dealing with tragedy in the ER vs the field
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
New panel: Fire officer/paramedic John, fire paramedic Jason, retired fire paramedic Terry and EMS medical director Kash
How to determine capacity and how this differs from competency
This becomes critical when doing refusals – when the patient decides not to be transported – a very high liability part of EMS
This is different than AAOX4
Capacity is very situational and specific, competency is determined by a judge
We determine capacity:
They must communicate a clear choice, an understanding of their current situation, understanding the risks and benefits of refusing or accepting care
Suicidal thoughts mean the patient does not have the capacity to makes decisions for that particular aspect of their care
Back when I first started in EMS, we would routinely force a suicidal patient to go to the hospital. The current culture puts EMS crew safety as a higher priority. Meaning, if we don’t have the support of law enforcement, we are not going to force patients against their will to get a mental health evaluation
We talk about our relationship and reliance on our mental health evaluators
Documenting these difficult cases involving suicidality and capacity can be tough
One of the current challenges is assuring cooperation between EMS and PD to help safely transport a patient with suicidality but that is also a potential danger to providers
Involving medical control is critical in these difficult situations, especially with technological changes decreasing the difficulty
When in doubt, just make the consult
EMS trained physicians improve our ability to do our jobs as more and more emergency medicine physicians get this training, it can only benefit us
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
The difficult admissions are the generally weak, unable to walk with no acute findings. They typically do not uncover any acute findings while in the hospital
In the ED, we can probably do a better job of involving some of our resources like social work to really give the patient and their family a better understanding of what admission will and won’t accomplish for them
Part of the America culture does put us in unique situations as the elderly often do not live with their children anymore. Family live far apart and often cannot help each other when in need
No one blames the patient for the situation they are in, but we want to find the best solution to serve them
IM deals with the limitations of insurance much more than we do in the ED
Ultimately, each hospital group needs to establish a culture. What would you want done for your Grandma?
A little more work now on these difficult cases in the ED can have the downstream benefit of keeping admission beds open for your next shift
Dementia patients with progression of their disease process can be tricky to disposition as well
We don’t do the best job in our society of talking about the normal aging process and how to preserve our patient’s dignity and sense of self in that process
We are scared to death of death
What is the difference between Observation admission and Inpatient admission?
The care is the same regardless of the admission type
An observation admission is best thought of as a problem that could likely be handled in the outpatient setting if the patient had unfettered access to follow up to PCP and specialists
In-patient implies that they need resources only found in the hospital
In-patient vs obs can change over time, if nothing new is found, these statuses can change
Sean recommends the book Same As Ever by Morgan Housel
He talks about the changes in medicine being so gradual that they don’t make headlines, but they are dramatic over time none the less
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
EM and IM physicians don’t get a great insight into each other’s careers in medical school or in residency
Do hospitalists like doing consults as opposed to just taking admission requests?
Sean says, yes, because it gives us an opportunity to solve problems together. They want to be consulted as much as possible
Admissions would be greatly decreased if there was more robust outpatient follow up ability but various factors make this difficult
Sometimes a slight delay in coordinating with the hospitalist or social work etc can save an admission and therefore free up ER beds down the line
Not every conversation with the IM physician must be an admission request
When they are consulted, the expectation is that they put in a consultation note and see the patient
Looking at an admission as trying to “sell” something is the wrong way to look at it. If you have a clear story and objective data, you should be able to articulate why they need admission most of the time
What does the day look like for a hospitalist?
Admissions for our team are very easy early in the morning but rapidly ramp up during the afternoon
The admitting physician handles ER admissions, outside transfer direct admissions and ICU transfers to floor beds
Sean goes into some detail about the workflow and what his day looks like
What are the difficult admissions to handle?
We talk about one of the most difficult admissions we commonly see: An elderly patient with weakness, unable to walk but no acute findings
We talk through possible solutions to better care for these difficult cases
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
New panel with Adam and Sean. Emergency and IM medicine physicians
There is a study from 2023 called Battles to Burnout. Studying the role of inter-physician conflict in burnout. Primarily the conflict between emergency physicians and internal medicine physicians. A better relationship leads to less burnout
Sean moved from primary care to hospitalist medicine when COVID was at its peak
Adam, EM physician, returns to the show
Sean enjoys solving problems and that is what drew him to IM and hospitalist medicine, he did a 3-year residency
He brings up an important distinction of our mindsets in patient care. In the ED we are looking more to find the problem, but he looks to solve the problem in the hospital
In some ways, in the ED, we are a glorified triage. But more importantly, we are expected to be the second best in every specialty - the second best cardiologist, second best GI etc
We do still do a lot of problem solving in the ED as well, but we usually do have the skill of a lower cognitive switching cost, we can move between tasks quickly
We to have to take efficiency into consideration
Sean talks about the superpower of IM being storytelling – one of his struggles is finding the best story to explain to everyone involved what is going on with the patient – sometimes the ED does not give the best story
We need to help start the right story to help the IM physician on the back end to set them up for success
Our limitations using a text platform to communicate does make it hard to read the intent behind questions
With admission requests, Sean likes to hear what we think is going on. Not just a bunch of data points but rather the start of that story
Sean also likes to hear the chief complaint first, similar to what I like from our EMS crews
A 5- or 6-line paragraph max is sufficient, they start to worry when the paragraph gets longer that we either don’t know what’s going on or so much is going on its going to be a difficult case
As APP’s we don’t get a ton of training in admission request story telling so it’s an art we have to develop
An admission request is a great time to slow down and really think about all the details
Being an ER APP can be a difficult position when working as a team with a physician. We tend to adapt to the physician we are working with. We share tasks and sometimes don’t get all the same details on a given patient
Patient hand-offs are a big source of information loss and errors. We can tend to turn patient stories into a game of telephone in the ED before the story even gets to the hospitalist
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
A difficult aspect of the job is the poor understanding of the public of what we do in EMS, and the poor understanding that our non-EMS friends and family have of what we do
Those of us in EMS can understand each other better, we have seen the same tragedy and struggled with the same difficulties that are so hard to articulate
What does retirement look like from a career paramedic in EMS?
Casey struggles with this, it’s hard to think about not caring for patients anymore. The closer he gets to retirement, the more it looks a little less clear what that looks like exactly
Eddie isn’t planning retirement soon so he can help provide for his kids. He does have retirement investments and fire benefits
Advice for newbies in EMS:
If you are seeing warning signs of burnout, get counseling immediately. Don’t write it off or try to ignore it as normal
Eddie would not have tried to fight the warning signs of PTSD, he would have sought help much sooner
He did struggle with suicidal thoughts for a period of time – counseling was the solution. Sleep deprivation was a major factor in these thoughts for him
He had a breaking point where he felt ready to end his life – a counselor called him back at 2am and got him in quickly to talk and this helped him significantly. And he now feels the best he has mentally – it doesn’t control him anymore
Casey talks about how few make paramedicine a career, it’s a tough job and it has changed over his career, he recommends finding the fun. Learn new things. Self-reflection goes a long way
Recognize when you need to switch to a different place, organization or company as a paramedic
Casey: “I feel bad, because I don’t feel bad”
We all feel different and respond differently to the things we see - you don’t choose the things that affect you
Don’t be afraid to say something to your coworkers if you see something wrong, even though it’s hard and confrontational – this helped me significantly when a partner called me out early in my EMT career
We’ve lost people in EMS through the years, this is devastating. We share life with our partners and get to know them really well
When Eddie was feeling similar thoughts of suicide to our coworkers that committed suicide, it was a huge eye opener for him to see the grief of their loss
Bad calls can haunt you; we have all seen it in others and ourselves
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
I tell those EMT’s that want to go to PA school or further education to just skip paramedic school. Go to paramedic school if you want to be a paramedic
“I’m not doing it for the pay, I’m doing it because I love it.”
Being a paramedic puts you in a unique position to save someone’s life in the span of 5 minutes
Eddie took calls personally. He gave every call his everything
Sometimes the patients survive despite all the odds being against them and some die despite all the odds being in their favor
We have to remember to respect the patients that may not have earned it because it speaks more about who we are than who they are
We will always have patients that treat us poorly, but it is more about rising above and detaching
We have the privilege of taking care of people on their worst days
Eddie talks about how EMS caused him to mature quickly
You will always have to deal with Karens in emergency medicine, you must rise above their bad behavior
Patients deserve our professionalism and respect even when they may not have earned it
Eddie talks about the difference between being in the field as a paramedic and in the ED
Eddie talks about how important it is to treat your patient as a human and not be a robot but be a human yourself
We need to build rapport and trust with our patient in order for them to accept our plan of care
Often the concern is different than the chief complaint
We talk about how certain tasks become second nature and allow you to converse with patients simultaneously
Humor can really help improve your patients’ care if you can read the room accurately
You don’t have to be an extrovert to be successful in EMS
We talk about how, working in emergency medicine, it can really take all the social energy you have
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
We talk about the immense responsibility and stress of being a paramedic and the stress difference I’ve noticed moving to ER PA
Casey talks about RSI and how it still causes his palms to sweat
We should have a healthy respect for high level skills
As paramedics we can tend to focus too much on a complicated task and neglect the overall picture of what is happening with the patient, a good partner can really help avoid this
It can be really challenging with a partner that is not watching your back adequately and needs to be micromanaged
A good EMT anticipates the paramedics’ needs
Good BLS will lead to good ALS care
You have to trust yourself as a paramedic before you can trust your partner
The further you progress in medicine; you tend to stop advertising that you are in medicine
Sometimes the mistakes or the hard calls are easier to recall than the good calls or the victories
Casey talks about a rough pediatric call when he was a new paramedic
Fortunately, the really hard calls are few and far between
Eddie feels like the bad calls are how EMS has damaged him. He struggles to remember the good calls, or the calls where he felt like he did a perfect job
He lives with regret where he feels like he could have done better as well as the tragic calls and feels like this gets worse with time
Sometimes ignoring the trauma for years on end really ends up affecting you when you are older
The jokes can be a cover for how you really feel
But as a paramedic you have to detach and be above the fray, getting stuck in the same emotions as everyone else will not allow you to effectively do your job
Eddie talks about an incredibly tragic case he ran that always haunts him
Once you start getting into the mentality of BSI scene safe, you tend to start practicing that in all areas of life. You get used to always making sure you are safe
We talk about private ambulance and the difference between retirement and disability benefits from fire service
It’s really hard to switch from being a paramedic to another career after a certain period of time
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Best online EKG course you can finish in less than 4 hours:
Practical EKG Interpretation - Practical EMS
4 Category 1 CME credits - Fundamentals through advanced interpretation
Welcome our new panel Eddie and Casey, two very experienced paramedics
27 and 48 years in the field
Casey talks about AI potential in the field and a study he was involved in. Will AI help us or improve patient care? Will humans be needed at all?
Can AI replicate your gestalt?
Is our gestalt worth trusting normally anyway?
Why do we see so many paramedics using the career as a steppingstone to other careers, I certainly viewed it this way when I was a paramedic
Eddie talks about starting in EMS because he knew it was the right thing to do. It feels like that is getting lost due to the softening of medicine. Becoming a paramedic was harder, the barrier to entry was harder. Have we lost our pride in this being a career rather than a job?
I remember having a lot of accountability from my peers when I was a new paramedic. I had some level of fear that I would be criticized by other crews and physicians if I didn’t perform well
Is part of the difference a lack of feedback from peers and physicians?
Has EMS gotten too soft?
Casey wonders if we are not putting enough emphasis on accountability to our peers because of fear of offending people
We talk about how much fear there used to be of the medical directors. But the environment has changed positively in a lot of ways as we learn and grow from mistakes more than getting punished for them
We talk about being a new EMT, being cocky
Where are the people that want to stay as a paramedic as a career? Not everyone is cut out to make it a long-term career
Some people get stuck in EMS, Eddie and Casey were more intentional about choosing it as their life
For some people it’s a job, for some it’s a life
How we present ourselves to the patient is important, we have limited time to make an impression and gain their trust
EMS has had periods where different services have just needed “butts in seats” and maybe this led to decreased expectations
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Whatever your beliefs regarding God or lack of a God as you work in emergency medicine, I hope this episode will uplift and encourage you
Laurie likes to reflect on the one patient she was there to help during the day. Or the one patient she was there to interact with
It is important to reflect on your highs, your lows and even things that made you laugh
Where is that line of caring for people and balancing your own family and priorities?
Jesus said the poor you will have with you always. You will never be able to fix every problem. We can’t take on a God complex. We have to check on ourselves to know when we are giving too much of ourselves
Daniel raises a point in his book, that the fruits of the Spirit are produced by you going through difficult situations with difficult people
Overcoming difficult things can make us better if we allow it to and we can be a light to those around us
Every day is not “I am blessed and highly favored”, there are some days where you feel bright and full and others where everything is difficult
Jesus knows that the pain of getting well is sometimes greater than the pain of staying stuck
Is emergency medicine your purpose?
Eric talks about the blessing it is to directly impact another person, but it is not his life’s mission. His identity is not an ER physician, it is a child of God
Laurie overall agrees but she stresses that she is called to be an ER PA. It’s the expression of the skills God has given her
I think I am somewhere in between the two of them, I definitely feel called to work in the ED but don’t want it to be my whole identity either
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Whatever your beliefs regarding God or lack of a God as you work in emergency medicine, I hope this episode will uplift and encourage you
Daniel talks about how the most anxious person in the room gets the most attention, but we should strive to be the non-anxious presence in the room. The non-anxious presence rebukes and resets the system
Daniel talks about how the people of God should strive to be like Jesus on the boat when he slept during the storm and say “Peace, be still” to the chaos
Remember how we treat people reflects who we are
Emotional whiplash occurs as a pastor or as an emergency medical professional
Daniel has gone from dedicating a newborn baby to helping a patient pass peacefully
Habits to hit the reset button:
I like to walk to patient rooms rather than speed walking. This allows me to take a deep breath, practice mindfulness and reset myself to approach the encounter well
Slow is smooth, smooth is fast
Try to smile
Engage with the patients that fill your cup and appreciate your care, talk with that staff member that is kind and happy
Daniel talks about breath prayers: “Come Lord Jesus”, “help me Lord,” “Lord I need you here” “Come Holy Spirit”
Daniel talks about how we help with anxiety. When he sees people in his office at church or in the hospital, they are often anxious just like our patients
He says one way he combats anxiety is asking the person’s full name. What does your middle name mean? Is that a family name? He quickly digs into the details about a person’s life, and this can cause the anxiety to diminish. It shows interest in the person
The greatest sound to a person is the sound of their own name
Often the patients chief concern is not the same as their chief complaint
In order to give to others, you have to have a full cup first, then what overflows is what you have available for others
How do we unburden ourselves of the things we take on at work?
Eric can compartmentalize
Laurie talks with her spouse to digest the things that happen during the day
Personally, sometimes I want to talk about my day and other times I don’t want to talk at all about my day
Daniel talks about how to avoid “taking home the hitchhikers.” We often see sad stories in our line of work and we can’t allow this to negatively impact our close relationships
Daniel jumps on his trampoline, screams into a pillow or goes to a steam room and gives the burdens over to the Lord. He also doesn’t shield his life from his family. He shares the difficult things
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Whatever your beliefs regarding God or lack of a God as you work in emergency medicine, I hope this episode will uplift and encourage you
New panel! Welcome Pastor Daniel Grothe, ER Physician Eric and ER PA Laurie
Daniel talks about the life of a pastor, which isn’t exactly as we all might assume. He talks about being a brand new, young pastor and how he responded to the home after the suicide of a 16-year-old boy
One of his first calls as the pastor on-call was the death of a 7-month-old boy
His experience, being a young pastor, not fully trained in how to handle the most difficult of scenarios, but jumping in anyway is not dissimilar to being a new EMT or paramedic
He’s not worrying about the medicine aspects like we do but his frequency of dealing with death and dying is very similar to my experience
He talks about how we come into peoples lives where they are and try to bring healing to them, and this can be costly for us as well
The ratios of doing the big things like weddings and sermons to the dealing with death and dying is not what you might expect as a pastor, a large portion of time is spent walking through the valley of the shadow of death with others
Laurie talks about an ER she used to work at and the amount of trauma they saw that was often not survivable
I recount the cardiac arrest of a 4-year-old I ran years ago and how this caused me to wrestle with God
Daniel talks about the times he has wrestled with God. Including the time New Life Church had an active shooter on campus that killed two young girls
Christians often want to see things like the stories in the book of Acts, miracles. But Acts takes place in 5 cities over 40 years. So, Daniel says, stick around a place for 40 years and you will see all of those things happen while also attending funerals and seeing death
Why do bad things happen to good people?
Daniel looks at what we do as working on this side of eternity to participate with God to be God’s representative to those that are suffering
We all get into the field to help others, but this can get lost in the tasks we have to do during the day
We have to remember that our actions and how we treat patients, regardless of complaint can demonstrate God’s love
Burnout comradery is a problem when we all get in a feedback cycle of complaining about the day and the patients. It might feel good in the moment, but it leads to burnout
“That smelly homeless person that just puked on my shoes is made in the image of God”
We can choose to be the peace and calm in every scenario
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Kevin Hazzard
Author of A Thousand Naked Strangers and American Sirens (you can find these on Amazon or wherever books are sold). You can find Kevin Hazzard at KevinHazzard.com
Kevin talks about the story Jesus told of the good Samaritan as really the first example of EMS. Jesus tells this story in response to a lawyer asking him how to obtain eternal life. A man was attacked on the road and left for dead. Many people that society perceives as “good” pass by this man but a Samaritan took the time to stop, dress his wounds and takes him somewhere to put a roof over his head and allow him to heal
Kevin talks about how society has never put sustained efforts into saving people outside of the hospital until the 60’s
The white paper published in the 60’s indicated that you were more likely to survive a gunshot wound in the Vietnam war than in the streets of the United States because you would have someone trained in first aid at your side
There was significant emphasis on intubation for early paramedics. This was a skill very important to the early physicians because they knew the life saving potential
We talk about the evolution of intubation and how emphasis seems to be changing and the important of still training on this skill because it can be very difficult and high stress
I think it is important to increase training rather than remove a skill set from paramedics
We talk about video options for intubation and the potential future of training
The first paramedics in American Sirens were black men that served their community called “The Hill”
Pittsburgh in the 1960’s was a very difficult city for African Americans. Jobs were not available. They were told they had no value. Then Freedom House ambulance gave them a purpose designed by the father of CPR himself, Peter Safar
Going from not worthy of anything to being trusted with paramedicine at the highest level for your own neighbors, your own community
The first call they run is in the aftermath of Dr. Martin Luther King Jr’s assassination
Peter Safar, the father of CPR and an anesthesiologist, designed the early ambulances in a configuration that is still used today, a captains chair because he wanted good access to the airway
Their first medical director, Nancy Caroline, wrote the foundational EMT education text book
The great tragedy is no one can really tell you about Freedom House ambulance until now, the story was intentionally buried and forgotten
“This need to be corrected,” Kevin Hazzard tells the important story
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Kevin Hazzard
Author of A Thousand Naked Strangers and American Sirens (you can find these on Amazon or wherever books are sold). You can find Kevin Hazzard at KevinHazzard.com
What does Kevin miss about EMS?
He misses the partnerships and the chaos you went through together.
The memories he has are both good and bad from his time in EMS, the failures and the mistakes but also the victories
We get into Kevin’s newest book American Sirens
We talk about the difficulties in controlling and bringing order to a chaotic scene and how this is a skill that has to be developed over time
Kevin tells a story about a call with a panic attack and how this may be normal for us but for the patient experiencing the symptoms, it may be a real unique and scary scenario
Kevin’s “large” partner would take control of the scene that was out of control by pushing the biggest dude up against a wall and then everyone else would back down
Even without size on your side you have to present external confidence on scenes
A situation that, by definition, is out of control, must be controlled
Even those scenes that are not out of control, you still need to convince grandpa that you will take great care of grandma and you understand how important she is
We talk about the story of John in American Sirens and how EMS gave him purpose and how EMS gave us purpose as well
John was a black man that grew up in a segregated city, extreme poverty, his mother died of alcoholism and his father ultimately had to give him up to an orphanage. But John didn’t give up and he saw the respect and dignity that was given the earliest paramedics at Freedom House ambulance, even as black men, and worked his way into practicing paramedicine at the highest level
This was a time that, in the city of Pittsburgh, if you had a medical emergency, it was handled by two cops
Kevin does a great job of articulating Johns full circle in the book. He goes from orderly, the lowest of the lows in the hospital, to practicing paramedicine at the highest level, intubation, and bringing in critical patients into the same hospital ED
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Kevin Hazzard
Author of A Thousand Naked Strangers and American Sirens (you can find these on Amazon or wherever books are sold). You can find Kevin Hazzard at KevinHazzard.com
We talk about the difference of caring for someone dying in their home vs the hospital bed
There is something more intimate about dealing with death in a home, where the person had lived
In a lot of way this is harder to deal with in a patient’s home than my role in the ER as a PA, where I have more resources to manage the family dynamics
Kevin talks about how the crew emphasized the fighting component of the job when he did his early EMT ride-a-longs. We talk about fighting patients and how a lot of times this can be avoided. It comes down to your relationship with the patient and how you present yourself. Many fights are unavoidable, but some are inevitable
Kevin talks about being more tourist than devoted to learning early in his career. About how a partner helped make him a true believer
Our partners make such a huge difference, they can show us how the job is or is not supposed to be done
“You should wake up every day excited to be here and learn the medicine”
There’s no mystical force we tap into, it’s about learning the medicine. It’s you and another human being with a few tools at your disposal
Appreciate the incredible opportunity you have to be there
Kevin talks about his stent as a paragod and how this came to an end
“Hubris comes before the fall”
Kevin talks about an embarrassing moment that ended his paragod phase when he brought in a cardiac arrest with lividity
Humbling experiences will occur and end that paragod phase, hopefully you learn from your mistakes
We talk about moving on from EMS and how the options are really limited for a paramedic looking to progress. There is no natural movement upward
Kevin talks about the struggle of identifying with a profession like paramedicine or being a firefighter and how this can make it difficult to move on, even when you should
It was hard for him to move on when being a paramedic was such a big part of who he was and was the motivating factor behind writing A Thousand Naked Strangers
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Kevin Hazzard
Author of A Thousand Naked Strangers and American Sirens (you can find these on Amazon or wherever books are sold). You can find Kevin Hazzard at KevinHazzard.com
Paramedic from 2004-2013 for Grady hospital in Atlanta
He talks about the self-doubt he had in the writing process and how he wasn’t sure anyone would relate to his stories
However, the specific details he describes are super relatable for those of us with experience in EMS
Kevin talks about the writing process, getting book deals and his work on Hollywood films/movies
He talks about how he got a lot of “no’s” before he found a literary agent and a publisher
His motivation for writing was to tell the journey of who he was at the beginning of his career in EMS and who he had became
Expect that you will get a lot of no’s and a lot of failure until you get the right agent. Find an agent that sees your vision that you can build a relationship with
A Thousand Naked Strangers was published in 2016
Kevin wrote one of the best accounts of the EMT school experience I have ever read
Imposter syndrome seems to be a newer term but is a feeling we all have, especially in EMT school this is a common experience
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Don’t make your career your entire personality, extra shifts will affect you over time. Sometimes the extra money is not worth the burnout
The culture is shifting from working a ton to a better work life balance
Your family will remember that extra shift you worked far longer than your employer
Get off on time
Control the variables you can control that give you higher chance of getting off on time
Leave work at work
Burnout can be short term or long term, acute or chronic
If you cannot take care of yourself, you cannot take care of others well
Strive to live a healthy lifestyle
Don’t let your relationships falter because you are too busy
Don’t take those patients that are terrible to you personally. We are seeing patients on the worst day of their lives
The environment we work in is one of the most challenging out there
Learn what burnout looks like for you individually
Schedule time to relax and spend time with friends
Have a system for overcoming burnout, maybe therapy, maybe exercise
You have to manage and recognize compassion fatigue to avoid taking out your stress on other people that don’t deserve it
Don’t wear things as a badge of honor that are not good things: like not drinking water all shift
Avoid the bad habits that allow a short-term benefit for a long-term detriment
Selflessness is a big part of who we are, but this can be a point of damage if you don’t take care of yourself
Understand that we are all working as a team. You have to understand your role and work efficiently within that role
Lucas talks about a very personal experience with EMS, law enforcement and the ER. He realized that anyone of these people could have been the last to see his son alive. And we are that for other people many times. We are a tribe.
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Batching work applies with nurses too. Do multiples things when you enter the room, so you don’t have to go in and out many times
Ben talks about efficiency in the field being important due to the limited time and resources
As providers we must get comfortable with saying “I don’t know”
In medicine in general we don’t know everything, nor can we diagnose everything. Especially true in emergency medicine
Chest pain is a great example. We don’t get a clear answer or diagnose most of the time
We must be careful what we tell patients is going on when there is not a clear answer. Specific diagnoses will follow patient for a long time
Ben talks about some struggles new EMT and paramedics have and how the scope of a paramedic is still poorly understood, they often hear “I didn’t know you could do that?”
Teaching the EMT and paramedic students the context of the “why” behind treatments and not just the skills themselves
The difference between magic and medicine is we can trouble shoot and analyze medicine, we know why it works and if it doesn’t there is usually an explanation
Keep your mind open and learn from others. You can usually find someone that has a similar style as you, but you can also learn a ton from those who practice different from you
Ask a lot of questions, grow your confidence gradually
You need to master the more mundane tasks before moving to the exciting in some circumstances
Charge nurses need to help develop their team and communicate well
Be a mentor and correct people in a non-public setting, grow people instead of getting rid of them if they are struggling
Find a mentor or multiple mentors when you are new and when you have some experience, mentor people
You must be constantly teaching newer people and learning from more experienced people in medicine
You can make or break someone’s medical experience when they are new to the field
Cultures can be developed by the poor attitudes of a few crews or staff
You have to guard against the bias that those that are burned out can bring
Constructive criticism can come from even those that are not nice or not tactful if you can be open enough to take the feedback
You can learn from anyone, even those lower on the perceived hierarchy
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
New panel! Lucas (ER physician), Kendra (Charge RN, NP student), Ben (paramedic and educator)
Kendra talks about her advice for new charge RN’s
Have some ER experience first. She says it was difficult starting as a charge when she was so new to ER. Have a good set foundation.
You need to be able to have difficult conversations with people in a tactful way to address problems
Getting to know the providers on a more personal level also allows you to better counteract interpersonal conflicts
Lucas talks about how a good charge nurse is a problem solver. He doesn’t view himself as the captain of the ship as an ER physician. He views the charge nurse as the problem solver and it’s their job to make sure every patient is managed in the department
The progression from EMT to paramedic is a similar advancement as RN to charge RN. Thinking outside the box instead of just task-oriented work
Paramedics must learn to allocate resources appropriately rather than do the tasks themselves
Simulation based training has help new paramedics learn to lead calls and see the time it takes for tasks to get completed
Paramedics do tend to have chips on their shoulders, a lot of this has to do with the difficulty of the job and how it is fairly new by comparison and the history of EMS is often us trying to prove ourselves
Lucas discusses efficiency tips in the ED
Chart with the same basic structure regardless of the chief complaint
The physical exam can be very basic and general with a very detailed focused physical exam based on the complaint
Sometimes documenting a physical exam that is too thorough can bite you later when you have to answer why you did a cranial nerve exam on an abdominal pain patient
Document what was done and do what you document
More is not always better
Document twice as much as you think you need to on the relevant components
When you are new as a physician or APP you should be ordering more and documenting more
Try to batch tasks. When you get up go see multiple patients rather than one at a time
It’s better to do the right tests rather than use a shot gun approach every time
You should be able to answer what you are looking for with a given test
On most patients, you should be able to form a plan after getting the HPI and physical exam
We should seek to avoid stacking orders, sometimes it’s inevitable when unexpected results pop up
Stacking orders reall
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Lorihodges.com
(4) Lori Hodges, MA, CCP, PMP | LinkedIn
Shaking In The Forest: Finding Light in the Darkness: Hodges, Lori R.: 9798888244005: Amazon.com: Books
Debriefing helps to learn from a big crisis and then move on without continuing to judge yourself and your mistakes
We all make mistakes, getting stuck in the mindset of constantly reviewing what you could have done differently and dwelling on it is not helpful long term and can impact your next patient if you are distracted
It’s okay to not be okay and seek help for the things you are struggling with. We need to talk more about this in EMS
We see things that humans are not meant to see. We must be intentional about healing from the trauma
We all develop positive and negative coping mechanisms. We need to be aware of these
Dark humor is one of these strategies we commonly use
Lori talks about the hypervigilance she developed growing up with her father as an alcoholic. She picks up on subtle cues that others might miss as a result
It is important to take concerns from other emergency providers seriously, especially if they are spending more time with the patient. It’s important to build that trust with those around you
Finding the balance between compassion and carrying another’s burden is difficult
It’s also important to be able to teach others in emergencies by allowing them to make the decisions themselves but also being there to catch them
Lori talks about how she trains new emergency managers by allowing them to do hard things while being there to support them
Lori talks about how sometimes allowing people to learn from their mistakes instead of just firing them makes for better managers
Allowing people to admit their mistakes makes for a better environment where everyone is improving instead of being afraid to admit their errors
Collateral beauty is the light in the darkness, that must be
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Lorihodges.com
(4) Lori Hodges, MA, CCP, PMP | LinkedIn
Shaking In The Forest: Finding Light in the Darkness: Hodges, Lori R.: 9798888244005: Amazon.com: Books
Lori Hodges, is the author of Shaking in the Forest, Finding Light in the Darkness. She is a former paramedic and firefighter in Colorado and currently works as an emergency manager, recently working on hurricane Milton in Florida.
She talks about trusting your paramedic intuition on scenes and gives a vivid example of how trusting herself on a scene, despite others adamant that there were no other victims on scene, found another ejection victim of a motor vehicle accident
We talk about some of the unexplainable experiences we have as paramedics and how many of us have these similar stories
Lori talks about a feeling she would get the morning of a shift where she would know that a patient would die before it would actually happen and how the feeling would resolve after running the call
I always try to take the patient more seriously when the EMS crews have been concerned enough to put on the defibrillation pads
An important rule in EMS is no running and no yelling. We must be the calm. Lori talks about how this is even more important as an emergency manager. As leaders, we are watched and people take their cues from us. They will tend to mirror our behavior
We have to detach to make sure we take everything in and not get stuck doing one specific task
It is hard to be the one that stands back and doesn’t do the skills as a new paramedic, but it helps you take in the whole picture
Lori dealt with addiction and it’s affects while working at a detox center. She also dealt with it personally in her relationship with her father. She had to learn to set up boundaries with him
Our partners and fellow EMS coworkers are fighting their own battles, remember to have grace for people. Sometimes how they come across is not how they intend
EMS challenges
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Kelly Grayson is a very experienced paramedic, educator, speaker and author that serves the EMS community.
You can follow him here:
(10) Kelly Grayson (@AmboDriver) / X
(20+) Facebook
You can find his books on Amazon
Amazon.com: On Scene: More Stories of Life, Death and Everything In Between (A Paramedic's Stories of Life, Death and Everything In Between Book 2) eBook : Grayson, Steven "Kelly" : Kindle Store
En Route: A Paramedic's Stories of Life, Death and Everything In Between: Grayson, Steven Kelly: 9781537770819: Amazon.com: Books
How to compartmentalize and do our job without losing our humanity. This is a balance we are all trying to find
Kelly talks about how he had to detach in order to quickly triage on a scene and how this is necessary to do the job a lot of times
Joy and pain are different sides of the same coin; if you insulate from one you deny the enjoyment of the other
If you don’t let the failure to resuscitate a pediatric patient bother you, how can you feel the joy of delivering a baby?
Often we are spending more time with the lowest of society rather than on our own health and well-being
You have to be able to step away from EMS and leave work at work. But we all know this is very difficult. You need to share your feelings with your family. Holding it all inside is not helpful
Kelly talks about how this lack of communication cost him a
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Kelly Grayson is a very experienced paramedic, educator, speaker and author that serves the EMS community.
You can follow him here:
(10) Kelly Grayson (@AmboDriver) / X
(20+) Facebook
You can find his books on Amazon
Amazon.com: On Scene: More Stories of Life, Death and Everything In Between (A Paramedic's Stories of Life, Death and Everything In Between Book 2) eBook : Grayson, Steven "Kelly" : Kindle Store
En Route: A Paramedic's Stories of Life, Death and Everything In Between: Grayson, Steven Kelly: 9781537770819: Amazon.com: Books
Kelly talks about how he was cocky for many years when he first started as a paramedic. Paramedics often go one of two routes: God’s gift to paramedicine or bringing their text books around in fear every day
Kelly re published En route and On Scene the way he meant to release them in the first place in 2023
A lot of us go through the “God’s gift to paramedicine” phase of our career when we are overly-confident when we are new
Kelly tells a moving story about an elderly woman and how not everyone wants to be saved
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Nick talks about a difficult RSI intubation and his struggle to overcome the feeling that he didn’t do his best
We talk about how intubation success was such a critical point as a paramedic that everyone would have judged you on in the past
We talk about the direct laryngoscopy vs the new video techniques
Advice for the newbies:
Brent: You’re going to struggle with burnout. You need to recognize it early. Prepare for that possibility.
Nick: The things that affect you are different for everyone. Certain things you think may not affect you will actually become a problem for you later. You can’t choose the things that you will struggle with. Always treat the patient well and don’t blame them for the problem they are having. It is not all about you. Treat people with respect and give them options. Let them save face.
Mark: Recognize that your happiness is up to you. Don’t expect the company or organization to give you your happiness or your wellbeing. If you see yourself getting less happy, you don’t owe the organization anything. You make the decisions that affect your life. We can’t blame the environment we choose. Make a change if you need to.
The mountain will always be the mountain. We have better gear than we did before but that doesn’t make the challenge itself that much easier. EMS is tough field and that will always be the case
Knowing when to step away is also important
Nick’s metaphor: Event horizons are the edge of a black hole. If you were in space and you passed into an event horizon you probably wouldn’t even notice. But from the outside, you would just appear to disappear. Event horizons appear in our careers as well. You may not really understand you are at that point of terminal burnout but looking back you might be able to pinpoint that point of no return that you crossed.
Where is the event horizon on a call? That point of no return where the outcome is assured.
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Nick talks about a difficult traffic accident and how something that seems like not a big deal but actually affected him – we can’t choose the things that affect us
Is there something protective in the fire or law enforcement world that helps with longevity? Is it the wider variety of calls?
EMDR (eye movement desensitization and reprocessing) is a form of psychotherapy that Nick had some great results from utilizing and highly recommends to those struggling
Working together as a tribe is a key aspect of a functional scene. Everyone has their roles, their strengths and they complement each other
When things would go bad, Nick would take all the responsibility on himself but share the successes with everyone
Nick talks about an officer that was vulnerable enough to go into the details about a difficult call where he ended up struggling for his life and how this inspired him to get some help and talk about past trauma as well
It is important to recognize your need for help before it becomes a big problem
Our experience on the panel leads us to believe that we are more likely to respond in anger as men in EMS – maybe that prevents us from seeking help sooner
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Why did Nick switch to law enforcement? He burned out on medicine
What does he miss the most: The team mentality. The fire crews that he grew close to. He felt certain they could handle whatever call came their way
We talk about the struggles working a 48-hour shift with a rural fire department but also having to manage the expectation from the private ambulance company that you run calls in a much wider radius to include the city when needed
Sleep deprivation is a big factor in burnout
Nick talks about his heavy caffeine intake and how he started having runs of dysrhythmia that later required a cardiac ablation for atrial flutter
What does Nick not miss? Getting up to run calls. The tiredness. The anger and helplessness
I remember getting to my absolute wits end on those 48-hour shifts and having to call our supervisor and tell them we were done running calls because we were so tired
Nick talks about how he could feel that stress and sleep deprivation damaging him in real time, like if his hand was on fire
The stress level of running those calls an hour from the hospital with no other paramedic on scene and having to perform high level skills has not been matched as a PA in the ED
Nick talks about how, even in law enforcement, his fear of the next call is not equal to what it was as a paramedic
Brent talks about a time when Nick was so angry he started stabbing his seat belt
Don’t blame the patient for their medical emergencies and don’t take your frustrations out on them
Nick talks about losing his temper on an innocent dispatcher after a hard night
Why do we see more resiliency and less burnout on the fire side?
Maybe the team mentality on the fire department, ability to move to slower shifts, debriefing
We all tend to get support after that horrific call that makes the news, but a bigger problem might be the micro-traumas that we all undergo day in and day out
Resiliency needs to be built into the system – you are going to get burned out and have a tough day at some point and it needs to be prepared for
We don’t typically lie to ourselves that we are “okay,” we may genuinely feel okay. It’s later that situations and calls may affect us
Status code 4 is a non-profit for first responders that is doing some great work – Look them up if you need more support
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Mark (paramedic) | Brent (fire officer and EMT) | Nick (former paramedic and current police officer)
Mark has worked in urban and very rural 911 ambulances and does part time EMT education now
Community paramedicine is an emerging field and can vary a lot from region to region. Paramedics are flexible providers, so the potential is huge
Brent has stuck with firefighting from his early days as a recruit all the way to becoming a fire officer
Nick has transitioned from EMS to law enforcement in the last several years
The history of the spine board is a good lesson for new people: The way we practice medicine is a constantly moving target. Best practice is not always based on good data. We used to put EVERYONE on a spine board, but this has turned out to likely be doing more harm than good
Even though logically something might make sense, it doesn’t mean it always does in reality. Backboards and epi are big examples of this
Mark talks about the history of backboards and how this practice came to be
An important point to remember in emergency medicine: If you have nothing really wrong with you, we are more likely to harm you than help you with treatment. This is because nothing comes without risk and if there is truly nothing to treat, the scale weighs entirely to the risk side.
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Nate talks about a motorcycle crash he stopped at on his way home and how he was critical in saving an injured patient and how he became close with the family who still talk to him today. Even though the patient ultimately died, the impact he made on that family was immense.
Patients remember us
We need to remember we treat a person not a complaint or a room number
The balance is finding the human connection while not over-empathizing and taking on burdens that are not yours to bare
We talk about moral injury vs burnout – I do agree that we do not need to blame the individual for their burnout. It is certainly caused from many factors outside of their control factor BUT I like to place the responsibility for overcoming burnout on the individual because no one is coming to save us. Looking to blame external factors doesn’t help us in the long run
Mental health struggles are not always obvious to us in people we spend time with
Casey talks about how the cooperate leaders are actually trying to do the right thing for the front-line workers in spite of what we might think about them
What advice for yourself 5-10 years ago?
Nate: Slow down. Listen to those with experience. Bring your love of the job to someone else, especially new people.
Kash: Remember that you don’t have to do everything on your own. EM is a team sport.
Aaron: Enjoy teaching the newbies. You can make or break their experience based on your affect.
Casey: Journal your days in EMS. The babies you deliver. The skills you perform. Something to look back on can be very valuable.
We mean a lot to new people and students so remember the influence you have on people
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
The paradigm around rapid sequence intubation is evolving and becoming much safer with more education and procedures.
Sometimes in emergency medicine slow is better. We need to stay mindful and calm in chaos and this requires us to detach and be above the fray and walk slowly instead of run. This will actually increase effectiveness and efficiency.
Nate recounts his EMT rides with myself and a great paramedic partner I had named Justin
Nate actually paid in EMT school to do more third rides so he could learn from the crews that were good at teaching
Crews can make or break an EMT students experience
Nate talks about how you really have to love EMS. The things we see are difficult, the shifts are long, the pay is not great. Something has to get you through
What affects one person may not affect another.
Casey talks about how it can be tough when things don’t affect you at all. That can be a form of struggle as well.
We talk about some of the hardest things to see in EMS, the cries of a mother or father at the loss of a child.
I talk about, how as an ER PA, I am a little more insulated from the death and the conversations with family than I was as a paramedic.
Nate talks about looking for the good differences you make with people. His job is not to save a life but to prolong lives.
Be intentional about marking those good moments
Casey talks about how a patients family remembered him long after a call
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
EMS varies significantly from state to state so you get a wide range in the abilities of EMT’s and paramedics nation wide
Case reviews are moving to an educational rather than a punitive model
There is no true national standard for EMT’s and paramedic’s which further complicates things
The regions that EMS is practiced in vary a ton as well. Skills may need to be performed much more frequently in an urban area vs a very rural area
Senior, experienced providers should use opportunities to show the newbies how to do skills rather than perform them themselves
One of the hardest parts of being a paramedic is standing back and delegating instead of doing the actual skills
EMS still falls under the department of transportation which is the department it was founded under
Standardization nationwide for EMS practice is difficult for multiple reasons, a big one is EMS needs and patients can vary a lot from region to region. Call volumes are very different from region to region.
Support the show
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here:Practical EKG Interpretation - Practical EMSearn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Meet our new panel
Kash (EM physician)
Casey (Paramedic)
Nate (EMT)
Why emergency medicine?
Kash: Likes to see results in the short term rather than manage long-term problems. Decided on EM and even an EMS fellowship before starting med school after getting his EMT
Aaron: When in PA school you really need to be at least considering primary care but I decided it was not for me. A day in primary care tended to really drag for me while emergency medicine makes the day go by quickly
Nate: Initially wanted to be a firefighter but enjoyed the medical side more and eventually got his EMT. He loves the diversity of the patients and the chance to help people. He loves critical care transport with the increased knowledge he has gained
Nate: Learn to slow down.
Kash: Don’t just do something, stand there.
Fix the underlying issue. Don’t just blindly treat numbers. Fix the why, don’t just react.
Casey talks about a scenario where slowing down was critical to catching important details during an RSI. Sometimes the whole team gets so focused on individual tasks that simple things (like low O2 sats) can get missed.
Checklists can be critical to making sure the simple doesn’t get missed
We all need to have humility
I address the video that got taken out of context after people thought we were directly comparing EMT’s to CNA’s. That was definitely not the intent.
Nate talks about how he is proud and protective about what we do in EMS
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1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...
Matt talks about our reliance on technology and how sometimes it is nice to remember that to assess a patient it is actually really simple without using technology
Andrew: I am mostly paid to not get tricked into missing something big.
Standards in medical education changing when there is emphasis on getting people through programs
Keep holding high standards for your students
Advice for the newbies:
Andrew: You won’t fail if you are trying your best and making the best decisions you can and caring for the patient
Aaron: Take care of yourself before you take care of patients
Matt: Ask for help if you need it.
Julie: Be content with where you are at
Sarah: Progress further in medicine if you can do it
Schasny: Don’t listen to the naysayers. Zero to hero is possible because everyone is different
You can learn from all providers, even if they haven’t been in the field long. Sometimes experience can be greatly varied even with only a short amount of time in the career
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My favorite pre-workout supplement
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If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...
Imminent baby delivery stories
Burnout tips: avoid the overtime. Sometimes the extra money is not worth the additional life stress.
Make sure you get off on time and make that transition to home life.
Andrew uses audio books so he has something to look forward to while driving to and from shift.
Patients are often not even the source of our stress, it’s operational difficulties, interpersonal difficulties and decision fatigue.
Decision fatigue is a big issue we face in our home lives after a significant portion of our day being in fight and flight mode
We talk about driving lights and sirens to every call and the dangers associated with this to the crew and public
This likely doesn’t save lives in any meaningful way that justifies the danger
There is a big push to decrease the emergent responses
We talk about the hazards with emergent returns, the confusion other drivers may have, the danger for the patient and crews.
Road rage isn’t worth engaging in, remember that the bar to obtain a drivers license is very low and many of the meth-using patients we take care of will drive as well. You never know what kind of person is in that other car.
I bring back up the discussion of “Where is God is emergency medicine?”
We see the whole spectrum of life and death. We see people come back from the brink of death that logically shouldn’t and those that succumb that logically shouldn’t.
We talk about strategies to compartmentalize and move on to the next patient
Schasny talks about the traumatic life and medical experiences she has come through and how they have changed her view on religion
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If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...
The team mentality at all levels in the ED is key to a harmonious, efficient and effective environment
In EMS, this can be difficult on a given scene when you may not know the other responders all that well and it can be easy to get offended when no offense was meant
Developing a thick skin is important in emergency medicine. You can’t allow negative emotions of others to affect you all day long.
Patients can be really mean. This is just a fact that can be expected so you can make a plan to deal with it.
One of the cool things about being an emergency medicine provider is that we are the provider that the patient has access to any time of day or night. We are not a expert in any one specialty and that is okay.
Sarah talks about a rough shift in the fast-track part of the ED
Andrew talks about the first code he ran as a medical student and the impact it had on him
It is an honor to be there at a patients last moments and to help their families through it.
It is very easy to forget the human side of emergency medicine. Ask yourself how you would act if it was your family, you were taking care of.
Slow down. Focus on making a connection.
I naturally fall out of making that human connection, so I have to be intentional about connection it or I won’t happen.
Paramedics and EMT’s have a tendency to measure success and contentment by the acuity of the calls they run. I would venture to say we need a better metric: human connection. If you can connect with your patients, this will prevent burnout in your own life and improve your patient care as well.
Strategies for avoiding burnout: music on shift, nebulizing coffee to neutralize bad smells and planning trips
Crazy stickers for comedic relief
We talk about the inaccuracy of pain scales and alternate pain scales
Schasny talks about a patient with an ingrown toenail that got up and left after hearing multiple traumas and code blues announced overhead.
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If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...
Meet our new panel
Matt (EMT) Julie (RN) Sarah (paramedic) Schasny (paramedic) Andrew (EM physician)
Advice for the newbies: Don’t panic, it is not your emergency
Find the balance of detachment while still making sure the patient feels cared for and understood
Part of avoiding burnout is taking some time to access the human side of youself in caring for a patient while also not taking the emotional stuff home with you
You don’t know it all when you are new. You have just been deemed safe enough to do the job.
Knowing where your limits are is important when you are new
Don’t be afraid to ask more questions of those around you in the beginning
Being a new paramedic has its own challenges as there really is no one to consult or provide direct feedback after a treatment
Some ER physicians are not familiar with EMS protocols so have some grace for this situation
In the ED, we must remember that EMS crews have a ton of operational problems to overcome on calls AS WELL as treating the patient for an emergent condition.
Confidence and experience only come by running call after call. You must see a lot of patients.
Medicine is an art not an exact science
Multitasking as an ER provider is just rapidly changing between focuses but is a huge skill you have to develop
Be in the chaos but staying organized is key to this “multitasking”
Another difficulty as a new ER provider is figuring out the order in which to complete the tasks you have to do
Controlled drowning. New people need to be allowed to feel the pressure and the stress while still having a backup so they don’t experience this for the first time by themselves.
Find a method to not let tasks get forgotten.
I talk about overwhelm when I was a new PA
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If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...
Keep asking “why” do get to a full understanding of what is going on
As providers we do want questions asked of us if someone is not sure about something we ordered
Tracey has found techniques to avoid burnout despite 24 years in emergency medicine, she says it is very individualized how you overcome burnout
Belligerent patients do cause burnout and the job to be very difficult in general
Taking intentional time to connect with your patients will help overcome burnout
Tracey has advice to give patients grace
Adam: purpose in life is important to avoid burnout. He believes he is called to be here.
Exercise, spend time with family, move your body, work less or even work more now to work less later
Force yourself to be social on days off, even if you might not feel like it. This will often help your mental well-being.
Owning your mistakes is key to avoiding burnout
Understand we will make mistakes and even when everything goes perfect, we cannot save the patient every time
We really aren’t built to see a lot of the things we have to see in emergency medicine
Be patient with the patients we deal with. They are going through something that we are not and have concerns we may not know about. They are scared, they are frustrated.
You need to have a sense of humor and the ability to compartmentalize
Compartmentalization helps to move on to other tasks that need to be done
Kate tells a story about compartmentalization
It is okay to set boundaries with patients that push on the limits
Deescalating belligerent patients is a skill that can be learned
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My favorite creatine supplement
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If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...
We talk about EKG interpretation
Adam talks about the power of teaching
Ongoing learning is key to performing well in emergency medicine and medicine in general
We discuss confidence in emergency medicine and The Dunning-Kruger effect:
People with limited competence tend towards an overestimation of their abilities
It is very dangerous at the top of this curve before you recognize your limits
Most of us feel this effect when we are new to a new level or field
Building confidence depends on the individual
I talk about my own overestimation of my abilities as a new EMT
Your partner on the ambulance can really encourage or limit your interaction with the Dunning-Kruger Effect
Even Adam, who admittedly doesn’t lack confidence, took about 3 years as an attending to gain confidence
For Kim, it took about a year to really build confidence, but also notably in a busy system. However, she still wanted time before taking students. She did that at about the 3 year mark.
As a PA, I think experience teaches you where your limits are.
Adam often talks through complicated problems out loud while working in the ED
Kim makes a great point about experienced EMT’s lacking the background knowledge and the “why” behind treatments. This “why” is critical to learn in medicine
Adam tells a story about how the “why” is so important. You cannot blindly treat a number. You must take into account the whole clinical picture.
Doing nothing is the right answer sometimes.
I tell a story about a paramedic, Amanda, and how doing nothing was the right answer for a patient.
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If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...
Stress exposure in school is very helpful for real life practice
A good analogy for lay people: EMT is like CNA, AEMT is LPN, paramedic is RN. This helps people understand the progression of levels of care better
Paramedics need to be learning provider type assessments on rotation not nursing assessments
Kim talks about the zero to hero debate: Experience matters not just in emergency medicine. The main difference is the individuals drive and education
Kim talks about a hypoglycemic patient when she was a new paramedic
Kate talks about the difficulty in bringing up possible concerns with providers and how important it is for the providers and advocating for patients
Adam discusses listening to EMS and the patient and the importance of what the patient looked like before they got to you.
Understanding your EMS system is important as an ED provider
We talk about the value of interpreting lab work in the field
Support the Show.
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My favorite creatine supplement
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My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...
We meet our new panelists
Kate (EMT)
Kim (Paramedic and educator)
Tracey (Former paramedic and current PA)
Adam (Former paramedic and current EM physician)
Kate talks about how the public doesn’t know the difference between EMT’s and paramedics
Tracey talks about a humbling experience in her early career where she did not know where her equipment was in the ambulance
Kim talks about changes in paramedic and EMT education. Historically you retain 20% of the information in a lecture format. That has been increased to 80% retention with new techniques like switching to simulation and active learning techniques
Putting the responsibility on the students to perfect their skills is something they will have to maintain in the field as well
Switching to competency-based education from hours based has been a huge change
Simulation based training is very valuable. It teaches you techniques and de-escalation techniques that you can’t learn from text books
We talk about medical scenarios outside of work and how our skills come into play
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My favorite creatine supplement
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If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...
Be willing to speak up. Sometimes you might be the only person to notice something important.
We need resiliency in this field. We are all still learning, so stand up and advocate for your patient.
Regardless of your level of care, you need to advocate for your patient.
The hierarchy is largely in your mind. Don't be afraid to approach someone with a perceived higher status than your own.
Take ownership over patient care
Confidence varies in how long it takes to develop
Be willing to be uncomfortable, it is how you will continue to learn
Be willing to make mistakes
EMS to in-hospital care can be a steep learning curve even as an EMT
We talk IV’s and IO’s, staples, “foley buddies and “no no zones” discussion
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My favorite creatine supplement
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My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for ed...
Nate (EMT) shares his story and the issues he has been dealing with.
Nate overdosed on medication and ended up in inpatient psych care which helped him immensely.
He still feels grief from time to time but does have happiness more now.
Nate wants people to know that these struggles are real and you are not alone. Don’t be afraid to talk about it. Seek counseling and therapy.
The field we work in makes us prone to dealing with mental stress and health.
Dark humor is a method we use to move on to the next patient or next call.
Our job is to help the body heal itself, sometimes this doesn’t work and we can’t get caught up in the times when it doesn’t work. We must be comfortable outside of that control.
We can’t save everyone.
A bad partner or burned out partner on the ambulance can really ruin your experience. We all need to be willing to teach in a tactful nonjudgmental way.
Sometimes doing nothing is the right answer if a patient needs an OR and a rapid transport is necessary
If you want to support the show, follow the links below for some great health and fitness products.
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My favorite creatine supplement
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My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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We meet our new panel:
Eric (EM Physician)
Shelby (EMT)
Nate (EMT) and returning guest
Sam (Prior EMT, ER RN)
DeTessa (ER RN)
Part of the fun part of the ER is getting to start from scratch and figure out the puzzle
Stories do change as the patient talks with different providers
We are not equipped to diagnosis or resolve chronic problems in the ED, we can’t provide every answer for every symptom
The mindset of the public of what the ER is vs reality is often quite different
We do need to understand that waiting for your ER work up can be very difficult as a patient, especially when you are in pain.
We need to have grace for this patient perspective
We talk about GSW patients and chaos that is present on scene and in the hospital
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My favorite creatine supplement
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My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Chris and I talk about my background and motivation for my podcast.
I talk about a pediatric arrest I ran that had a huge impact on me.
We tend to dehumanize patients in this job to keep our distance, but that is not always the best technique.
Emergency standards are standards I have developed working in the ER.
One of those standards is to walk slowly through the department. Become mindful. Be intentional and in the moment. Think through the proper order to complete your tasks. It is not your emergency.
Mindfulness practices are key to mitigating anxiety and stress.
Getting off work on time is key to separating work and life and maintaining that balance. Of course, much of this is outside your control, but control as much as you can.
Let the shift go before you get home. Refocus on the rest of your life.
Take care of yourself before you take care of patients. Self-care is critical.
Overtime is often needed when you need to focus on making money, but this cannot be sustained long term.
Daily, consistent discipline will prevent a crisis or emergency down the road.
Debriefing and talking through cases can help you process and heal from them.
Acute and chronic burnout are different problems and require different solutions.
Focus on the factors you have control over.
Know your why. A powerful why can overcome a lot of how’s.
Check out Mind the Frontline below and help their mission to improve lives of first responders:
Resilient Response: Self-Care Strategies for Emergency Medicine (mindthefrontline.org)
Support the Mission (mindthefrontline.org)
Support the Show.
Chris and I talk about my background and motivation for my podcast.
I talk about a pediatric arrest I ran that had a huge impact on me.
We tend to dehumanize patients in this job to keep our distance, but that is not always the best technique.
Emergency standards are standards I have developed working in the ER.
One of those standards is to walk slowly through the department. Become mindful. Be intentional and in the moment. Think through the proper order to complete your tasks. It is not your emergency.
Mindfulness practices are key to mitigating anxiety and stress.
Getting off work on time is key to separating work and life and maintaining that balance. Of course, much of this is outside your control, but control as much as you can.
Let the shift go before you get home. Refocus on the rest of your life.
Take care of yourself before you take care of patients. Self-care is critical.
Overtime is often needed when you need to focus on making money, but this cannot be sustained long term.
Daily, consistent discipline will prevent a crisis or emergency down the road.
Debriefing and talking through cases can help you process and heal from them.
Acute and chronic burnout are different problems and require different solutions.
Focus on the factors you have control over.
Know your why. A powerful why can overcome a lot of how’s.
Check out Mind the Frontline below and help their mission to improve lives of first responders:
Resilient Response: Self-Care Strategies for Emergency Medicine (mindthefrontline.org)
Support the Mission (mindthefrontline.org)
Support the Show.
Wrapping up our conversation with Brian and Kristina (PA’s and prior paramedics) and Casey (paramedic)
Shadow PAs in different specialties so you really know what the career looks like practically.
Use this to find out what specialties you like, school doesn’t always give you enough time and you may not get a job in your desired specialty every time.
You must know WHY you want to be a PA. Have a very clear understanding.
Don’t be completely set on working in the ER as a new PA. There are a lot of other valuable specialties to gain experience in before going to the ER.
Paramedics are well equipped with knowledge and experience for PA school. There is a lot more to learn but, in many ways, paramedics are one of the best careers to transition to PA from.
Most of medicine does not understand the high level of training that paramedics receive.
If you are an EMT planning on PA school, learn from your paramedics.
In EMS, learn from those with experience regardless of their provider level.
If you want to support the show, follow the links below for some great health and fitness products.
My favorite protein:
https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS
My favorite 1ST Phorm Energy Drinks:
https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS
My favorite creatine supplement
https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS
My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Support the Show.
We jump back into our conversation with Brian, Kristina and Casey
Advice for newbies
Reflect on the calls that you run.
What went well and what went poorly?
Are there providers that did a great job that are worth emulating?
Find those mentors that are worth emulating. Also make note of those that are worth avoiding.
Keep in mind there are multiple right ways to do things.
All of us in emergency medicine need to be ready to teach. Students and patients.
The ability to teach demonstrates true understanding.
Teach your thought process.
Going from EMS to PA.
It is not a quick process, and it is very expensive.
It is hard on your family. You need a support system. You may be lonely.
Paramedics, in a lot of ways, are well prepared to go to PA school but their skill set is not equipped to manage diseases long term.
A lot of what most PA’s do is specialty work on disease processes long term and not emergent conditions.
Being an ER PA is a lot different than it may appear from the outside. A lot of our job is care provided away from the patient. We tend to be the limiting factor, so we have to use our time efficiently. We are isolated from tasks that allow you to do the work reflexively.
If you want to support the show, follow the links below for some great health and fitness products.
My favorite protein:
https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS
My favorite 1ST Phorm Energy Drinks:
https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS
My favorite creatine supplement
https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS
My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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We meet our new panelists
Brian and Kristina (PA’s and former paramedic’s). Casey is back!
Transitioning from paramedic to PA
Professionalism is a big emphasis in PA school.
This was something I learned as an EMT from a great paramedic partner early in my career as well.
Professionalism in EMS is a cultural and personal aspect to strive for.
PA school also wants you to keep in mind you are representing their program and PA’s in general.
Teaching the newbies
We all need to have the confidence to pull aside the newbies and make them aware of dangerous overconfidence and arrogance when we see it.
Even though it is confrontational.
Seek out mentors when you are new.
Be a mentor for new people because sometimes they aren’t confident enough to ask for one.
We don’t really have to find the exact problem that the patient is having, we are trying to figure out what the patient needs.
Be an investigator.
If you want to support the show, follow the links below for some great health and fitness products.
My favorite protein:
https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS
My favorite 1ST Phorm Energy Drinks:
https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS
My favorite creatine supplement
https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS
My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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We discuss what things we want others to know about our careers.
In EMS we can tend to jump immediately to being confrontational, even when the other person isn’t meaning to be confrontational.
We all have different scopes and different levels of knowledge.
Casey wants people to know that paramedic’s get extensive training in 12 lead interpretation.
Lucas wants people to know that doctors are not the boss or supervisor or the manager, we are a team and we each have our roles.
Egos tend to make people see the system in a hierarchy. We all need to be willing to teach and check our ego.
A good EMT will catch things that paramedics are missing.
Nurses are hard workers and tend to be on their feet longer than paramedics.
Advice for newbies:
You can’t save everyone, regardless of how well you function.
The job is not all emergencies.
Take care of yourself before you take care of others. There may be times when you must prioritize other things in life, but long term, you must take care of yourself.
Have an identity outside of your profession.
Create rituals that help you perform during your day.
Casey prays every day before his shift to be his best self and take the best care of his patients.
Keep a journal. You may want the specifics of certain details later in life.
Create healthy hobbies.
If you want to support the show, follow the links below for some great health and fitness products.
My favorite protein:
https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS
My favorite 1ST Phorm Energy Drinks:
https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS
My favorite creatine supplement
https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS
My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Meaningful patient interactions – Hold on to them.
The mundane calls, the rude patients, the horrible things we see - those are the price we pay for the one call where you save someone or have a meaningful interaction.
It is an honor to take care of patients that can’t get help in any other medical setting except the ER.
Find one thing every shift that you find fulfilling. Be intentional. Find that thing. Someone sweet, someone grateful, someone you helped.
You need the right expectations. Not every patient is dying, and too much high acuity will actually take its toll on you as well.
Micaela talks about the MCI she ran and her question of how could God be present in the destruction. She came to realize that God is not in the event, He’s in the healing and the processing of the event.
Providers should be educating those with less education and that want to learn.
Some things get easier with time, and you don’t have to think about them as much.
If you want to support the show, follow the links below for some great health and fitness products.
My favorite protein:
https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS
My favorite 1ST Phorm Energy Drinks:
https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS
My favorite creatine supplement
https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS
My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Support the Show.
Our new panelists:
Lucas- ER Physician, Micaela- Paramedic, Alex- Paramedic, Rebecca- ER RN, Casey- Paramedic
We discuss struggles with caring for patients that have perpetrated violent crimes.
Recognize your own bias and your personal history that may affect patient care.
It’s important to have a good self-care plan because you can’t pour from an empty cup.
Pediatric calls will stick with you. They require intentionality to overcome.
We all carry scars with us.
Understand that we are human, and it is normal to feel emotions, but we owe it to our next patient to continue to be our best self.
Don’t miss opportunities to tell your family and friends you love them. Life is fragile.
Find the “thing” that works for you to help you heal from the things we see. Exercise, walk, talk with someone, watch a movie.
Overcome the challenges in a healthy way. Healing instead of coping.
Embrace the beautiful moments.
If you want to support the show, follow the links below for some great health and fitness products.
My favorite 1ST Phorm Energy Drinks:
https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS
My favorite creatine supplement
https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS
My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Struggles in emergency medicine
Casey struggles with keeping up with the changes, especially the technological changes.
If you worry about keeping up, put yourself in a position to teach the new people. They will force you to learn as well.
Micaela talks about her personal struggle with burnout and the significantly high acuity calls she has run
She ran a ton of high acuity in a short amount of time. She had difficult partners and students. She was a critical part of a shooting that made national news. She was medical control on a significant MCI as well.
Some paramedics will have periods of time that are much higher acuity than normal.
Some EMS systems are so busy that you gain experience much faster than others.
Casey talks about a pediatric cardiac arrest that we were able to get back and had a good outcome.
Making that human connection is important to preventing burnout. But it needs to be done with some wisdom. We cannot pick up burdens all day that our not ours to bear.
Physical touch has power.
We all want to connect with patients, but this is difficult in certain settings. You must balance this with the emergent patients that require more of your time.
Burnout is avoided by connecting with patients.
If you get to know them, they might surprise you with their amazing stories.
If you want to support the show, follow the links below for some great health and fitness products.
My favorite 1ST Phorm Energy Drinks:
https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS
My favorite creatine supplement
https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS
My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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We welcome our new panelists.
Micaela (paramedic)
Simone (former ER RN and now ER NP)
Paramedic’s Alex and Casey returning.
Simone gives us a glimpse into the tough transition from ER RN to ER NP.
You need to love the medicine. Having to know so much of so many things was one of the toughest parts.
You must be second best at every specialty.
Alex talks about the transition from EMT to paramedic.
Being in a system that creates strong EMT’s makes the process easier.
Being able to think back to times when you were an EMT and what your paramedic did in certain scenarios is a great frame of reference.
Transitions like this are difficult to explain until you have lived them. Not having that safety net is a big difference.
Confidence only comes after practice in the field, not in school.
Don’t make the mistake of thinking you know everything. It can be a dangerous mentality.
Critical procedures should always be taken with the seriousness they deserve.
Casey talks about pericardiocentesis (please follow your protocols)
Cricothyrotomy stories
Casey takes about doing this in the back of a helicopter.
Think about having to cric every time you intubate a difficult airway.
RSI discussion
My favorite creatine supplement
https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS
My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Support the Show.
Emergent Standards
I address a comment about how we mentally handle the patients we care for that have committed violent crimes. We still care for them to the best of our ability; in fact we often learn the whole story after we have finished caring for them. We don’t judge because that is not our role. We find ways to move on from the horrible situation.
Emergency standard:
Take care of yourself before you take care of patients.
75 Hard has completely changed my mindset. I actually stick consistently to goals that I set for myself like never before. I can get up early before work and get myself in the right mental space to take care of patients to the best of my ability.
Practical tips:
Pack your food. Pack your water.
Track calories and macros.
Wake up early.
Daily exercise.
Leave for work early.
Wake up before your family.
My favorite creatine supplement
https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS
My favorite pre-workout supplement
https://1stphorm.com/products/project-1/?a_aid=PracticalEMS
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Support the Show.
Confidence in EMS:
Nate talks about how he was reaffirmed when learning ALS meds and a physician agreed with his treatment plan.
School does not make you confident.
As a provider, give the crews feedback because it helps them grow and confirm their plans and treatments were accurate. Don’t just give negative feedback.
Some students do need an extra push to make them uncomfortable enough to progress or realize how far they still must go. They need to develop critical thinking for when they have no safety net.
Running calls when you don’t agree with the other responders/providers:
Be blunt when you believe a treatment can be negligent. You must advocate for your patient even when this means confrontation.
Certain treatments have the potential to harm. Aggressive treatment is not always needed.
State where you stand when you disagree.
It can be difficult to broaden the differential when another provider is totally fixated on the initial impression.
We need to approach as a team. Have discussions. Be willing to consider your rationale for why you believe what is the right treatment path.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Support the show
Random stories episode!
We often don’t want to talk about the “craziest” call we’ve ever seen.
I tell a story about a fireplace fueled by batteries and no real medical reason for the call.
We talk about things that surprised you about emergency medicine
Dealing with drunk people is a challenge.
Other great random stories:
Thoric dissection’s, triple A’s, rhythm changes, driving lights and sirens, hitting deer, getting into accidents.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Jumping back into our discussion on alcohol abuse in EMS.
Everyone is susceptible to overuse of alcohol so abstaining can be powerful even without it being your vice.
Interpersonal communication skills are key to developing in EMS. We need to connect with our patients.
Patients care more about being understood and listened to than good medicine.
Advise for newbies:
It’s hard to admit when you have a problem but that is the first step to fixing it.
It’s okay to fail but you need to pick yourself quickly back up.
Know you are not alone with these vices, be it alcohol or something else.
You must be prepared for that next difficult call or life event. Because it is always coming.
It is helpful to have friends that do EM and friends that don’t do EM so you aren’t always centered around work.
Our dark humor in EM is needed to help put things on the back burner so we can move on in the moment, run that next call or see that next patient and deal with it later.
Sarah tells a story about a grandma that passed away then immediately running a baby being born.
Nate tells a story about connecting with a patient and that how that is the exact reason he got into medicine.
Kate talks about how it’s worth taking the time to explain things to patients.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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New panel!
We welcome Alex, paramedic and Kate, EMT.
Welcoming back Sarah, paramedic and Nate, EMT.
What makes a great paramedic?
Treat your EMT’s like a partner. Talk about calls. Teach your EMT’s. Educate without belittling.
Create an environment where your partners can question the plan if they don’t understand it.
Learn from those that have been doing this for awhile.
What makes a great EMT?
Ask questions.
Have desire to improve.
Nate talks about his struggle with alcohol
When you crave alcohol or vice in general, you usually have one of the following:
HALT: hunger, anger/anxiety, loneliness, tiredness.
Alcohol abuse is a huge problem in EMS.
It being so socially acceptable makes it more difficult to overcome.
Alex and Nate open up about how they have had success overcoming this vice.
EMT schools sound like they are doing a better job at preparing EMT’s in the skills needed to verbally deescalate a situation and empathize with patients.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Support the show
You guys ever see a dead family member in a patient? Like they look similar, act similarly?
No?
Maybe it’s just me.
Nate talks about his life experiences and how it helps him talk with patients that are struggling with mental health. He talks about a patient experience where he really connected with a patient and how the patient was seen years later having changed his life.
We talk about God in EMS and the really unfair and tragic things we see. How this will test your faith.
Kiley talks about how, seeing so much death, it’s seeing the patients themselves in their last moments that convincing her there is a God.
Burnout
Lean into your coworkers, share your feelings. Talk with people to help heal.
Follow up on that critical patient you are worried about.
Avoid substances.
Talk with people about how you feel.
Use those frustrations to exercise or do something productive.
Calls add up over time. Sometimes it not just one call, its multiple in a row
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
Support the show
Leadership in emergency medicine
Good nurse to patient ratios is very important to good patient care and allowing those little moments where you can spend some extra time making sure the patient feels cared for.
Management doesn’t always equal good leadership.
Part of being a good leader is being the calming presence in a chaotic scene or situation. Walk, don’t run. Be mindful. You can be freaking out internally but externally you must show confidence and calmness.
Sarah tells a story about going the extra mile to simply get a patient a coke. Sometimes these small things that we overlook make a huge difference to the patient and pay huge dividends to you personally.
It doesn’t take hardly any effort to go above and beyond.
Casey talks about a patient that he went the extra mile for and how it completely changed the patients’ affect from mean and grumpy to much happier and gracious with the staff. He remembers that case from 30 years ago because it made such a difference to him and made the job worthwhile.
This job is about service for others. If you don’t want to serve, you are in the wrong job.
A big risk with going zero to hero is you may have done a lot of work to find you don’t like the career.
You must be willing to teach and be taught in this field.
Burnout can really be decreased when we take short moments to make a patient feel cared for and listened to.
We need to make patients feel heard and treat them like human beings.
Casey tells another cool story about a stroke patient with resolved symptoms after he was able to deliver fast treatment.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Is burnout moral injury? Is it out of your control?
ZDoggMD talks about burnout being moral injury. Link here:
(30) It's Not Burnout, It's Moral Injury | Dr. Zubin Damania on Physician "Burnout" - YouTube
We jump back into our discussion on the video.
Casey says one of the great things about this job is that we have the privilege to be with people on their worst day.
Nate talks about the conflict we sometimes have one scene when treatment plans are not agreed upon. He talks about burnout from not trying to get to the source of a patient’s psychiatric problem and just medicating them.
Kiley talks about the reality of practice vs school and that we can’t fix every problem we encounter.
We can take the time to be empathetic and this can help combat burnout if you allow it.
The sorrowful aspect of our job is really difficult. You must know your limitations.
Kiley discusses how sometimes we can’t do much to help or even do adequate alleviation of pain, and all we can do is hold the patients hand.
We all got into this job to serve others and we can lose sight of that. We need to remember to express appreciation for each other in the quick moments we have before chaos descends again.
Leadership is key at every level in emergency medicine. Saying no to a bad plan takes some confidence and leadership skills.
A good leader takes weight off other people’s shoulders by leading well. By doing everything we can for a patient.
A good leader can take criticism and remains humble. They take the opinions of others into account.
When something goes well, give away the credit. When something goes wrong, take responsibility.
Good leaders know when to follow. They are not dictators.
When everyone leads at their own level, chaotic cases come together smoothly.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Jumping back into Principles in Emergency Medicine
Nate- People lie. Despite the fact that we are not judging them, and just need to know accurate details to provide the best possible care.
Casey- Expect the unexpected.
EMS is long periods of boredom punctuated by moments of sheer terror.
Adam- the job is always out to get you. We see the 1%, it is a self-selected population. So, if you are going to consider a rare or uncommon diagnosis, you are more likely to find it in these patients.
He found a passive pulmonary embolism in a patient with very mild and vague symptoms.
Casey- Arrogance can really cloud your judgment. You must be more confident in what you don’t know than what you do know.
Nate- pay attention to those subtle details like bradycardia. It could indicate a bigger problem than initially thought.
Watch your ego because it may cause you to focus too much on a differential and ignore details to the contrary.
Casey tells a story about a woman who was assumed to be drunk but just had a low blood sugar.
Adam- Know the difference between confident and cocky.
Kiley- A confident provider with a clear plan is very helpful to nursing staff because they can convey this to the patient, and everyone is on the same page.
I always plan on a negative work up because a positive work up will dictate the plan.
Sarah- Don’t stop learning. Look things up. Learn every day.
ZDoggMD talks about burnout being moral injury. Link here:
(30) It's Not Burnout, It's Moral Injury | Dr. Zubin Damania on Physician "Burnout" - YouTube
I agree with certain aspects of what he is discussing but I also believe there will always be aspects of our job we cannot control so we must remain focused on the things we do have control over. Ourselves. Our patient care. How we show up.
Adam- The emergency department is unique in medicine because we don’t have a lot of oversight and rules from the insurance companies. We can order the tests and take care of the patients **regardless of their race, gender, insurance coverage. We are the safety net of society.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm products. Check them out here so they know I sent you.**1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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We meet our new panel and some returning guests!
Kiley – ER RN and new NP
Sarah – Paramedic in EMS for 8 years
Welcome back Adam ( ER MD), Casey (paramedic) and Nate (EMT).
Nate talks about the transition from field EMT to ER EMT. It’s a new world with new things to learn.
Sometimes a change in environment can get you out of a rut.
Sarah also worked in the ER but as a paramedic and loved learning new aspects of medicine but her scope was diminished compared to the field.
Paramedics are still a new asset in the ED and have a fluid job description.
Principles in emergency medicine
1. We do not diagnose in the ER.
2. Take care of yourself before you take care of patients.
Sarah recommends outlets and hobbies that are totally separate from medicine.
Make yourself a priority or you will end up neglecting yourself.
Sleep deprivation will affect you more than you think.
Casey talks about how you can get lolled into relaxing by low acuity calls but then you may be tested to your limits the very next call.
Kiley talks about patient autonomy and how it is our job to present options and educate but the patient must ultimately decide to accept or reject our options whether we agree with it or not.
If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm products. Check them out here so they know I sent you.1st Phorm | The Foundation of High Performance Nutrition
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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We revisit the question “Where is God is emergency medicine?
Doug- I’m a believer in science and a believer in God.
There are some occurrences that we can’t explain with modern medicine. He tells the story of a cardiac arrest that woke back up an hour after pronouncement.
Sarah- God has given us the science to learn and be able to use.
We often see the victim of a horrible tragedy as well as the person that caused the trauma. It’s hard to believe there is a God when we see such injustice in the world.
I talk about the difficulty taking care of a drunk driver who was the reason for the death of his friend in the passenger seat.
Casey prays every day before work for the safety of his partners and that he would be the best paramedic he can be.
Casey tells an awesome story of recovery from a horrible head injury. How it redeemed this person from a bad path in life.
Advise for those struggling:
EMS changes every day. So, stick around and don’t give up.
Avoid substance abuse. Don’t neglect your emotions.
Hold on to the good calls.
Find something you’re passionate about outside of emergency medicine. Use it to get the frustration and the things that bother you out.
Take a break. Talk to someone.
If you are a nurse. Know that you have to be true to yourself and you can always switch nursing specialties if you need to.
Write down the victories.
You must be intentional with your mental health.
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Crazy stories episode
Delivering babies!
Not something most of us look forward to but it happens, nonetheless.
Casey talks about a breech presentation birth that, thankfully, turned out just fine despite delivering at 28 weeks in an ambulance as well as a prolapsed cord case.
Stabbing victims!
In a sex shop, in their homes, we run them everywhere.
Butt stories!
Stuck vibrators with full batteries, flashlights you name it.
Shitting in a trash can. This episode has it all.
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Pronouncing in the field is a difficult part of EMS. In a lot of ways, the ED insulates us from some of the aspects of this that make it challenging when you are in the patients actual home.
The ED is mentally taxing in other ways. High volume, high acuity, multitasking, consulting etc.
Nate talks about how “you’re just an EMT” gets thrown around a lot. Just because it’s a lower-level of education doesn’t mean that EMT’s don’t have valuable information and knowledge level.
Collaborate with your EMT’s and other providers to give patients better care.
It takes experience to understand that, regardless of care level or education level, everyone needs to be allowed to speak up.
Newer ED providers, LISTEN to the entire EMS report.
Casey- one of the most difficult things to hear is that heart wrenching scream that family gives when they arrive in the ED to find a dead loved one.
Casey tells a moving personally story about his son that died of cancer. How you return to the job after that kind of loss.
He talks about the family of public health and safety people that surrounded him and carried him through.
It is very difficult to see certain patients and not take it personally.
Child abuse cases are on the rise. Have a high suspicion with pediatric trauma. Listen to the details on scene and document them.
Casey talks about a traumatic call involving child abuse. Sometimes we must take care of the perpetrator of horrible crimes.
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Challenges in emergency medicine
Burnout can creep up on you and can occur even in one shift.
Nate got burned out working nights and started drinking heavily and almost got into blows with his partner. He went through a tough period and came out the other side.
Substances will become an easy outlet and a way to avoid dealing with real problems if you allow them.
Everyone has their coping strategies; you need healthy ones.
Casey- If you run 2000 calls a year or more you may burnout, if you less than 200 calls you may burnout.
You need a balance at a certain point. Being the right kind of busy can give you energy as well.
I cannot overemphasize how amazing the 75 hard program is.
In emergency medicine we need to be MENTALLY TOUGH
Try cold plunging.
Doug- recognize you are burned out. Some variety and less hours overtime can really help extend your time in EM.
Sarah- Recognize burnout in yourself. As a nurse you have job flexibility if you are getting burned out.
No one is going to remember that extra shift you worked except your family.
Life is not easy to balance and sometimes work will take priority or money will take priority but the more you keep your family on the back burner the more they will suffer.
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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Jumping back into failures in emergency medicine
Doug, ER physician, discusses how he missed a traumatic intraabdominal injury and an ectopic pregnancy. It’s easier in hindsight to see the things we could have done better. Admitting you screwed up can be difficult.
Leave work at work as much as possible
Nate talks about a patient that was initially written off as flu like symptoms, with no initial vitals being obtained that end up being in V-tach.
Anchoring bias is a big problem. Overcome your bias or you will miss something.
Doug, ER physician: The waters of emergency medicine are deep. You may be walking around in shallow water and then suddenly end up over your head.
Objective reports are much more helpful than biased ones
Nate, EMT: What’s the worst-case thing that could be going on with your patient? Start with the worst differential and work your way backwards.
Sarah, ER Nurse: We all strive for excellence, no one wants to miss something, but we are all capable of it. Hopefully we learn from the mistakes.
She tells a story of working a presumed cardiac arrest before checking a pulse.
She talks about a time where another nurse had to step in for her and advocate for a patient and she learned a tough lesson that she needs to be the one that steps up, no matter how uncomfortable and advocate for her patient.
Nate messes up an IO but initially didn’t want to admit his mistake.
FAIL STANDS FOR FIRST ATTEMPT IS LEARNING
Doug, ER physician: You must be able to move past a failure or this job isn’t for you. Things don’t always go right. If you haven’t failed yet, you will.
Casey, paramedic: You’re going to make mistakes. The culture is changing to make it easier to discuss mistakes with preceptors rather than be ridiculed.
HAVE EXTREME OWNERSHIP OVER YOUR FAILURES
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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January Panel Episode 1
We’ve got some awesome experience here today. Physician, Nurse, PA, paramedic and EMT!
We introduce Sarah, 9 year nurse with 4 years of experience in the ER. She is inspired by the team mentality in the ED as well as the unique situations. Inspired by her grandmother who was a nurse when emergency medicine was a developing specialty.
We welcome back Casey. Long time, experienced paramedic, practicing here for 30 years.
Nate is back. EMT for 9 years. Comes from a heavy past with suicide attempts, drug and alcohol abuse and has a passion for helping those in similar situations.
We welcome Doug, emergency medicine physician of 24 years. His love for science lead to him pursuing medicine and ultimately emergency medicine.
We talk about how medicine ends up so ingrained in you that doing something different really becomes impossible at a certain point.
I may have gotten myself stuck in a bathroom during a night and had to be saved by the lock picking abilities of talented ER physician.
Failures in emergency medicine
I talk about my failure to diagnose a PE in a patient and how, fortunately, my physician college was able to find it and the patient did well. But I learned, if you think about ordering the test, just order it.
Casey talks about how he gave the wrong medicine. He talks about complacency and the danger that can present to a patient when we are not diligent. He talks about missing an MI and how these things do happen, even to experienced people.
TAKE OWNERSHIP FOR FAILURES
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
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I discuss the position of an ER PA and how it relates to the physician role. I strongly believe in practicing as a team with physicians, I see this as integral to the PA career. We talk about autonomy as a EMT/paramedic or PA.
EMT’s and paramedic are a perfect career to step into the role of a PA because of their autonomy.
Teaching is a key part of medicine and especially important for physicians to teach others.
Adam explains what he would want people to know about being an ER physician. Difficulty with understanding EM as a specialist.
Les explains how in one shift a cardiologist was astounded by the fact that he performed a c-section and an obstetrician astounded by him putting in a pacemaker.
We talk about good reports from EMS crews and how we always need to start broad in our work ups.
WHERE IS GOD IN EMERGENCY MEDICINE?
I talk about a hard call I ran a few years ago, a pediatric arrest that made me question where God is in emergency medicine?
Casey talks about how he still believes in God with all that we see. How he is just an instrument. If it turns out bad or good, he was supposed to be there.
Ashaley believes that what she does is actually more special because of our limited time on this earth and the impact she has on her patients and the impact they have on her.
Les discusses the evil that we see every day and difficulty in the transition into our safe and normal family life.
Casey argues that there is more good than evil if you look for it.
Adam talks about his life experience and how he does not have the faith to be an atheist.
Kierra talks about how she can sustain her career because of her faith. She talks about a baby girl that was coded her in her ED. How she was left alone with the baby after she was pronounced. How she showed her love even though the baby wasn’t really there anymore.
Nathan talks about his struggles and how he takes care of patients. That he can still be someone’s answer to prayer and they can keep their faith if he helps them.
We actually make the transition to funny stories to end on a lighter note.
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Welcome Dr. Les to the show. Finished his EM residency in 1999, 24 years spend as an attending, estimates 130K patient seen in that time. He tells us about a busy night shift in the ED where he had to take care of an easy laceration but how the busyness of the night made him overlook something simple.
I follow this up with a story that makes me look like an idiot but sometimes it’s okay to laugh at yourself.
Les would tell his younger self that all the work he has done is worth it but some things don’t matter. Grinding is not always appreciated so killing yourself for the convenience of people is probably going to go unnoticed a lot of time.
Nathen talks about how EMT’s are often not listened to. If you aren’t listening to your EMT, you are missing a lot of valuable info and they can help you avoid getting stuck on a differential that no longer fits the picture.
Ashaley talks about challenges in critical care and flight vs the ambulance. The benefit of listening to/valuing volunteers and how much they care about their communities.
Casey talks about how TV shows will often depict paramedics as stupid and give the impression that they save everyone when the reality is they have a huge knowledge base and saving lives isn’t always possible.
Kierra gives us a story about advocating for your patient and sticking with it even when the provider disagrees.
I hope you guys enjoyed this episode. We have one more December panelist episode coming next week where we discuss a big topic I think you will really appreciate.
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We welcome a new panelist. Flight paramedic Ashaley. She has been in emergency medicine for 11 years.
Ashaley tells us about an impactful story from a patient that told her “Make sure you take moments. Life will always get out of control but, stop and go look at the sunset because sometimes you have things you can’t get back.”
Kierra talks about some stories she has from when she was newer nurse and was overwhelmed vs the ability and confidence that comes with experience. She shocked a patient BACK TO LIFE before a provider could even get in the room to see the patient.
Casey stress the importance of making a difference in just ONE patients life. If you can make an impact on just one person in all your years in emergency medicine, that IS ENOUGH.
Adam describes a scene where he had to go outside of the ED to find a DEAD BODY in a car.
I describe a call when I was an new EMT, running a cardiac arrest and trying to put on a brave face to impress an EMT student that took it really hard and started crying. I realized in that moment that it IS OKAY TO CRY.
Ashaley talks about a pediatric cardiac arrest and a partner that reminded her that it’s ok to take time to process after a call. You don’t always have to be ready to go out again immediately.
Adam stresses the importance of finding someone to help you OFFLOAD the hard things you see. Seek admin time and other uses of your time so you don’t have to spend it all in clinical shifts as an ER physician.
Kierra tells us that ER nurses don’t tend to last longer than a couple of years. She gives the advice that you should avoid working too many hours and overtime. Be patient as you learn. Figure out your why. Why are you doing this work? You need the why because the job is very draining without it.
Casey tells us to start a 401K and keep a journal about things you see and do. You may want that clarity later in life.
Nathan tell us how EMT’s ARE PROVIDERS and should be seeking to gain more knowledge.
This episode has a lot of takeaways. My biggest one was the fact that it is OKAY NOT TO BE OKAY. The culture of holding everything in is not healthy.
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Warning: This episode starts pretty heavy
We talk about an absolutely horrific and tragic call that Nathan ran and how he has healed from something no one should ever have to see.
Casey tells us about how patient's can impact us even in non-emergent settings. Casey and his partner help a patient attend his son's wedding and spark the inspiration for a nationwide program to help patient's that are bedbound attend special occasions for free.
Kierra tells us about the importance of taking your time with a patient.
Adam describes a patient that came into the ED at the height of Covid, basically at deaths door, with an unclear diagnosis and how God used him to save this life.
Emergency medicine can be very difficult on a daily basis. It can be thankless, hopeless and forces you to carry burdens that no one should have to carry.
My biggest take away from today's stories is the importance of holding onto those calls, those patients that impacted you for the good. Maybe you were able to save a life, maybe you were able to go above and beyond for a patient in a way that has nothing to do with medicine; either way, we need to hold those moments and those experiences closely to our hearts and our minds to give us the strength to run that next call or see that next patient.
Meet our December Panelists:
Nathan - EMT of 9 years
Casey - Paramedic of 47 years
Kierra - ER RN for 7 years
Aaron (host) - 15 years in EM as EMT, paramedic and ER PA
Adam - ER Physician with 21 years in EM
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**Real Stories in Emergency Medicine Part 1
Meeting our December panelists and diving into some real stories
Nathan - EMT of 9 years
Casey - Paramedic of 47 years
Kierra - ER RN for 7 years
Aaron (host) 15 years in EM as EMT, paramedic and ER PA
Adam - ER Physician with 21 years in EM**Do you work in emergency medicine? An absolutely crazy and intense environment where you see things every day that a regular person doesn’t see once in their entire life? Do you feel burned out, unappreciated and like there is no one you can talk to about the things you are struggling with? Well you are not alone. I have a bunch of real professionals with real stories here with me today that can relate to your struggles. My mission is to share stories that will uplift, encourage, educate and help you not just survive but thrive in emergency medicine.
By the end of this episode you will realize that you are not alone, you can succeed in this career and can leave your shift without being beaten down and discouraged.
I have struggled with burnout, discouragement and frustration at many times and still struggle with it. My name is Aaron, I’ve been in emergency medicine for 15 years as an EMT, paramedic and now EM PA and I am the host of the Practical EMS podcast.
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.
The central theme of this episode series is stories. Stories are a huge part of our human experience regardless of your profession. They help us make sense of the world. Each of us is made up of our own experiences and stories. This is even more notable in EM as we see things on a daily basis that impact us. We see things that could rival even the most dramatic TV depictions of the ER.
This causes huge highs and deep lows in our own emotions and can cause us to leave work on to of the world or crushed under its weight.
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**Full episode finally coming next Sunday!
Last teaser episode until the full episodes release starting next Sunday December 10th!**I introduce one of our final topics of discussion in the December panel series.
Where is God in emergency medicine?
This has been a question I have personally wrestled with over years of witnessing tragedy, horrific accidents and even some triumphs. I think it's easy when everything goes well. It's much more difficult to answer when things go wrong.
I hope my story makes you not feel so alone in the difficult situations that emergency medicine inevitably throws at you.
Subscribe so you don't miss our full panel discussion of this important topic!
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Real Stories in Emergency Medicine
Today's episode is a clip from our upcoming full episode on real stories in emergency medicine.
Kierra is an ER nurse that goes above and beyond for her patients. She helps give some perspective on what it's like to be a new ER nurse, what it's like after you have some experience and the amazing opportunities you have to save lives every day in the ED.
If you like this episode, subscribe so you don't miss the full release on Dec. 10th. And subscribe at PracticalEMS.com for the free newsletter and links to the video!
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I have a simple framework I wanted to lay out for the new EMT that is struggling to run a call. When I was a new EMT, my FTO would just throw me in there without a lot of guidance on HOW exactly a call worked and what the steps were exactly. If you follow these steps you won't get lost and can move the call along without any awkward pauses and blank stares.
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These steps work 95% of the time but have to be skipped if the patient is in cardiac arrest or needs emergent interventions.
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Obtain the HPI. Introduce yourself, ask their name and dig into why they called 911. OPQRST. This is to give yourself a clear idea of WHY you are there and how to proceed. You may need to redirect the patient a few times to stay CLEAR on what is going on TODAY not 10 years ago. You want to know pertinent history NOT everything that has ever happened to them. Example: They called for chest pain. When did it start? What makes it better/worse? What does it feel like? Does it radiate anywhere? How bad is it? Does it come and go? Do you have any cardiac or respiratory history? Get the answer to those questions and MOVE ON.
- Collect objective data. Get vitals, do a physical exam based on the CC, get an EKG if needed, blood sugar and IV if needed. This can happen simultaneously with step 1 and probably should.
- Any treatment needed? This is easier as an EMT than it is for a paramedic. Based on your treatment protocols, consider breathing treatment, IV fluids, dextrose, zofran. Example: our chest pain patient may need aspirin, zofran and and IV.
- Disposition (what now)? Can the patient stay home? Are you taking them to the ED via your ambulance? Is it appropriate to have family drive them? Are they going to refuse your recommended plan? Do the conservative option (ambulance to ED is safest for the patient)
Hope you guys find this helpful.
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Feeling burned out, tired, frustrated as you work in emergency medicine?
Are you an EMT, paramedic, nurse, PA, NP or physician? This show is for you.
Today, I talk to an ER veteran. Susi has been in the ED for 26 years and still shows up with an awesome attitude and still puts patients first.
She tells an awesome story about going above and beyond for a patient. She embodies the mindset you must have to not just survive in the ED but thrive for the long haul as well.
Find more valuable, encouraging content at PracticalEMS.com and subscribe to the email list so you don't miss an episode!
More stories coming soon!
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Excited to announce a new podcast format coming soon! I've got a great group of healthcare professionals coming in to tell some awesome stories from their experiences working in emergency medicine.
Stay tuned for more updates and subscribe at PracticalEMS.com so you don't miss the release!
Also subscribe to Practical EMS on your favorite podcast player so you get notified when the episode drops.
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This might be the NUMBER ONE SKILL you need to be successful in medicine, especially emergency medicine.
If you are newer to emergency medicine and you haven't had a patient surprise you or had a situation that humbled you, YOU LIKELY WILL SOON.
I think it's very important to adopt a humble and teachable mindset no matter where you find yourself in the world of medicine. Whether you are a student or experienced provider, people will respond to you better and you will be more of an asset to your patients when you are keenly aware of the fact that YOU DONT KNOW EVERYTHING. And you never will.
Just when I think I am becoming an expert and have seen and done it all, I am quickly reminded that I AM NOT INFALLIBLE.
I learned this quickly in PA school too. No one cared how much knowledge I had or how much patient experience I had as a paramedic. I stopped talking about my prior experiences and this hurt my ego but adopting a HUMBLE AND TEACHABLE mindset made everything else much easier. Especially interactions with preceptors.
If you don't put yourself up on a pedestal, it won't hurt so bad when you trip and fall.
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The Gap and The Gain, by Benjamin Hardy and Dan Sullivan is one of the few books I’ve read more than once. Despite its simplicity, I get something new out of it with each read and it is a great reminder of an important mindset that I always strive to achieve.
The GAP is the trap you fall into when you compare your current life with that of your ideal life or the next thing you are working toward: that income level, that certification, that license, that degree, that lifestyle.
The problem is, when you are constantly comparing your current life with that of your ideal life, you are pursuing happiness without actually ever achieving it.
The mindset change is to compare your current life with your past life.
Look at the GAIN. You have come through challenges and struggles to become the person you are now.
Measure backwards NOT forwards.
Stop pursuing happiness and live happy NOW. Guys, check out the book, I don’t do it justice.
Email me at Aaron@practicalems.com with any feedback, questions or ideas you may have.
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Overall, I think this change is positive and should allow better patient access to quality care while also maintaining the team mentality and collaboration that is critical to our relationship with physicians.
Full document at SB23-083 Fact Sheet.pdf (coloradopas.org)
Let me know what you guys think at Aaron@practicalEMS.com
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Why does efficiency matter?
Beds are a limited commodity and the next patient that needs one might be dying
Mindset changes
Stop trying to diagnose. Try to rule out emergent diagnoses and determine if patient is safe or not safe to send home. Plan on negative work up before it comes back
Sick vs Not Sick
Not an innate skill. It’s learned over time and many patient contacts. Will help you determine dispo before the work up is back.
#1 See ambulance patients first
Potentially the sickest patient in the department. Need orders to be placed.
2 ABD (Always be dispo’ing)
Discharge the patients that can go home and admit/consult those that need to stay or need a specialist BEFORE seeing new patients that have orders already placed.
#3 Run the board frequently
Should happen after each task that gets completed or new patient gets seen.
4 Strategically plan non-emergent procedures
Laceration repairs can wait until you get caught up on more important tasks. #5 Concise admission/consult requests
Few people want to read multiple paragraphs about why the patient is getting admitted. The reason should be clear enough to make concise.
#6 Chart as you go
Getting off late contributes to burnout and you should be signing charts with each disposition. #7 Don’t repeat work that has already been done
If we are working as a team with a physician, you don’t need to repeat the HPI/PE, focus on following results and do the back end work like consults/admissions/reassessments and discharges. #8 Show up like the day is going to be a complete disaster
You won’t be disappointed. Show up early because on-time is late. You should be looked up to by staff as the calm in the storm.
#9 Plan your exit early
Don’t sign up for patients in the last hour if you won’t be able to complete a dispo. Plan on which patients will need to be handed off to the next provider and have a CLEAR plan to make the next providers job easier. #10 Use other providers as a resource
Use the experienced providers you work with as a quick source of education.
#11 Over communicate with ED staff
Nurses can help you out a lot if they know the plan. Delegating tasks is fine but as you get faster, it may be quicker to call lab, x-ray, CT yourself to clarify things are getting done and not lost in the shuffle.
12 Place orders, than chart
If a patient doesn’t have orders in, the clock is ticking but nothing is getting done.
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Super excited to share this episode with you guys. This was one of my favorite conversations I’ve had yet.
Sara Townsend of Phoenix Fitness has a great story to share and amazing advice for women in firefighting, but men would do well to listen too.
Sara Townsend is an amazing wife, mother, entrepreneur, fitness coach and retired firefighter paramedic. Founder of Phoenix Fitness https://www.facebook.com/groups/470021078290261/ where she helps women and men pass their CPAT with 100% success rate.
Check it out at www.myphoenixfitness.com
We talk about how difficult it is to have a miscarriage while still having to be at work caring for other people’s emergencies. This was something I struggled with in PA school during clinicals and I can’t even imagine how hard this would be as the woman going back to firefighting.
There’s no doubt that fitness is important in EMS, especially firefighting. This is a topic that pretty much everyone has room to improve upon; whether it’s better sleep, hydration, mental health or exercise.
If you have any doubt on your ability to pass a CPAT or are struggling in the fire service as a woman please check out Phoenix Fitness for some top notch coaching. https://www.myphoenixfitness.com/
Email me at Aaron@practicalems.com with any feedback, questions or ideas you may have.
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I have no experience with triathlons. I would have never considered myself athletic. I've run one race longer a 5k my entire life. I decided that a half ironman would be a very ambitious race to train for and complete.
I'm a big believer in trying hard things that put you outside of your comfort zone to help improve yourself as a human. You don't even need to know everything about a difficult task before you start. Colin O'Brady talks in his book, The 12 Hour Walk, about life's 1's and 10's. In his many physical accomplishments, like hiking across Antarctica, he has had a lot of 1's: almost dying, being so physically exhausted that he thought this task was going to prove impossible. But he claims that these "1's" are there so you can experience the 10's in life: finishing a task so big that no other human can claim to have finished.
This is what the half ironman represented for me. An ambitious task that sounded almost impossible. It required me keeping a lot of commitments to myself. It required me to start training without all the head knowledge already in place and learn along the way. There were a lot of 1's in this journey but it was totally worth it for the 10 of crossing that finish line and seeing my wife and two girls waiting for me. Whatever your ambition I want to encourage you to get started. You don't have to know all the ends and outs. You don't have to even feel confident you can finish. Just start. Take little steps each day and the finish line with be there before you know it.
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Part 2 of our discussion, this was available to premium members two weeks ago so join for FREE so you don’t have to wait! Three amazing ER RN’s give some great advice to our EMS crews as well as new APP’s. This was a really fun discussion with Meredith Thomson (ER RN, with lots of years’ experience on the ambulance as well), Amy Christopher Pryor (ER Charge RN) and Jeremy Hulsker (ER Charge RN).
We talked a lot about our EMS crews as seen through the eyes of ER nursing and I think there is a lot of valuable information in seeing patients and situations from their perspective.
They also give some great advice to new APP’s that are climbing that steep learning curve that is emergency medicine.
Communication is key. Accepting feedback is key. We are all here to help the patient and open discussions with your nurses about the plan and goals on a given patient interaction go a long way to speed up the processes as well as decrease the chances of patient harm.
Our local EMS agencies do a great job in the field with far less resources than we have in the ED. Nursing has noticed a significant improvement in the communication from EMS over the last few years. But it can certainly be a challenge to keep up with all the trauma, stroke and sepsis criteria of multiple hospital systems in a region.
Our prehospital providers are always on always on my mind because it is where I practiced medicine for so long as a paramedic. So I hope I don’t come across overly critical in my efforts to educate you guys about the things I wish I knew when I was practicing as a paramedic.
Email me at Aaron@practicalems.com with any feedback, questions or ideas you may have.
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If you don't want to wait to see Part 2, join now as a premium member to hear the entire discussion! Three amazing ER RN's give some great advice to our EMS crews as well as new APP's. This was a really fun discussion with Meredith Thomson (ER RN, with lots of years' experience on the ambulance as well), Amy Christopher Pryor (ER Charge RN) and Jeremy Hulsker (ER Charge RN
We talked a lot about our EMS crews as seen through the eyes of ER nursing and I think there is a lot of valuable information in seeing patients and situations from their perspective.
They also give some great advice to new APP's that are climbing that steep learning curve that is emergency medicine.
Communication is key. Accepting feedback is key. We are all here to help the patient and open discussions with your nurses about the plan and goals on a given patient interaction go a long way to speed up the processes as well as decrease the chances of patient harm.
Our local EMS agencies do a great job in the field with far less resources than we have in the ED. Nursing has noticed a significant improvement in the communication from EMS over the last few years. But it can certainly be a challenge to keep up with all the trauma, stroke and sepsis criteria of multiple hospital systems in a region.
Our prehospital providers are always on always on my mind because it is where I practiced medicine for so long as a paramedic. So I hope I don't come across overly critical in my efforts to educate you guys about the things I wish I knew when I was practicing as a paramedic.
Email me at Aaron@practicalems.com with any feedback, questions or ideas you may have.
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Subscriber-only episode
Thanks for joining as premium member! Three amazing ER RN's give some great advice to our EMS crews as well as new APP's. This was a really fun discussion with Meredith Thomson (ER RN, with lots of years' experience on the ambulance as well), Amy Christopher Pryor (ER Charge RN) and Jeremy Hulsker (ER Charge RN
We talked a lot about our EMS crews as seen through the eyes of ER nursing and I think there is a lot of valuable information in seeing patients and situations from their perspective.
They also give some great advice to new APP's that are climbing that steep learning curve that is emergency medicine.
Communication is key. Accepting feedback is key. We are all here to help the patient and open discussions with your nurses about the plan and goals on a given patient interaction go a long way to speed up the processes as well as decrease the chances of patient harm.
Our local EMS agencies do a great job in the field with far less resources than we have in the ED. Nursing has noticed a significant improvement in the communication from EMS over the last few years. But it can certainly be a challenge to keep up with all the trauma, stroke and sepsis criteria of multiple hospital systems in a region.
Our prehospital providers are always on always on my mind because it is where I practiced medicine for so long as a paramedic. So I hope I don't come across overly critical in my efforts to educate you guys about the things I wish I knew when I was practicing as a paramedic.
Email me at Aaron@practicalems.com with any feedback, questions or ideas you may have.
Benn Taylor and I review the body cam footage from the unfortunate case in Illinois from last year where the EMS crew has been charged with murder and discuss lessons to be learned from this as well as professionalism in EMS in general.
How we present ourselves to the public matters. How we treat people matters.
Most of us that have been doing this for any period of time have had those partners that have great bed side manner and treat all people with dignity and respect.
We've also had those partners that are burned out, lack any compassion and have a tendency to escalate every volatile patient encounter.
We all initially got into EMS out of a desire to help and serve other people and when we find ourselves in a mindset that is anything close to what this crew displayed, we must recalibrate.
Always start with the assumption that a patient has as life threat until proven otherwise. When you start by assuming the patient is "not sick" these types of encounters have higher potential of recurring.
Subscriber-only episode
Thanks for joining as premium member! Benn Taylor and I review the body cam footage from the unfortunate case in Illinois from last year where the EMS crew has been charged with murder and discuss lessons to be learned from this as well as professionalism in EMS in general
How we present ourselves to the public matters. How we treat people matters.
Most of us that have been doing this for any period of time have had those partners that have great bed side manner and treat all people with dignity and respect.
We've also had those partners that are burned out, lack any compassion and have a tendency to escalate every volatile patient encounter.
We all initially got into EMS out of a desire to help and serve other people and when we find ourselves in a mindset that is anything close to what this crew displayed, we must recalibrate.
Always start with the assumption that a patient has as life threat until proven otherwise. When you start by assuming the patient is "not sick" these types of encounters have higher potential of recurring.
Full episode up now for Premium members at PracticalEMS.com! Benn Taylor and I review the body cam footage from the unfortunate case in Illinois from last year where the EMS crew has been charged with murder and discuss lessons to be learned from this as well as professionalism in EMS in general.
Check out the episode at the website to see the body cam footage.
How we present ourselves to the public matters. How we treat people matters.
Most of us that have been doing this for any period of time have had those partners that have great bed side manner and treat all people with dignity and respect.
We've also had those partners that are burned out, lack any compassion and have a tendency to escalate every volatile patient encounter.
We all initially got into EMS out of a desire to help and serve other people and when we find ourselves in a mindset that is anything close to what this crew displayed, we must recalibrate.
Always start with the assumption that a patient has as life threat until proven otherwise. When you start by assuming the patient is "not sick" these types of encounters have higher potential of recurring.
2nd half of our hour long discussion. Premium members got to see this two weeks ago!
Video up at PracticalEMS.com
NP and PA school do not prepare you for the steep learning curve that is emergency medicine. As APP’s we often don’t do a residency program and have to jump in and learn on the job in order to succeed. The environments we practice in are as varied as the physicians we will often practice side by side with. Dr. Adam Bariteau is an emergency medicine physician and former paramedic. I have personally learned a ton from him and he has helped me succeed in the ED from a new APP to a slightly more experienced APP. He often can be found teaching medical students and new APP’s in the ED while also maintaining the efficient pace that is needed in EM. He gives some great advice and tactics for surviving in the ED as a new APP that I think you will find valuable and make the job a little less daunting. As a lot of my audience is EMT’s, paramedics and nurses, I think this will give you a glimpse into the struggles that new APP’s have as well as insight into our relationship with the physicians. Hopefully, it will also help you make that leap if you are debating the APP route. As always, email me anytime at Aaron@practicalEMS.com and give me your feedback.
To access full episode, join as premium podcast subscriber.
NP and PA school do not prepare you for the steep learning curve that is emergency medicine. As APP’s we often don’t do a residency program and have to jump in and learn on the job in order to succeed. The environments we practice in are as varied as the physicians we will often practice side by side with. Dr. Adam Bariteau is an emergency medicine physician and former paramedic. I have personally learned a ton from him and he has helped me succeed in the ED from a new APP to a slightly more experienced APP. He often can be found teaching medical students and new APP’s in the ED while also maintaining the efficient pace that is needed in EM. He gives some great advice and tactics for surviving in the ED as a new APP that I think you will find valuable and make the job a little less daunting. As a lot of my audience is EMT’s, paramedics and nurses, I think this will give you a glimpse into the struggles that new APP’s have as well as insight into our relationship with the physicians. Hopefully, it will also help you make that leap if you are debating the APP route. As always, email me anytime at Aaron@practicalEMS.com and give me your feedback.
Subscriber-only episode
Premium members get access to the entire episode early! I hope you find some value in this episode!
NP and PA school do not prepare you for the steep learning curve that is emergency medicine. As APP’s we often don’t do a residency program and have to jump in and learn on the job in order to succeed. The environments we practice in are as varied as the physicians we will often practice side by side with. Dr. Adam Bariteau is an emergency medicine physician and former paramedic. I have personally learned a ton from him and he has helped me succeed in the ED from a new APP to a slightly more experienced APP. He often can be found teaching medical students and new APP’s in the ED while also maintaining the efficient pace that is needed in EM. He gives some great advice and tactics for surviving in the ED as a new APP that I think you will find valuable and make the job a little less daunting. As a lot of my audience is EMT’s, paramedics and nurses, I think this will give you a glimpse into the struggles that new APP’s have as well as insight into our relationship with the physicians. Hopefully, it will also help you make that leap if you are debating the APP route. As always, email me anytime at Aaron@practicalEMS.com and give me your feedback.
Full interview with Dr. Adam Bariteau will be live soon at PracticalEMS.com, make sure to subscribe to be notified when it is posted.
Subscribe on your favorite podcast player to access the full episode and support Practical EMS!
Continuing my discussion with Cody, Chris and Vince around scene management and etiquette.
Believe me, I've made all the mistakes you can make as an EMT and Paramedic. My goal is to help YOU avoid these mistakes and decrease the amount of miscommunication and confrontation on scenes with other providers. At the end of the day it's all about the PATIENT. That is what we are all here for.
A recurrent theme in the discussion is RESPECT. Respect for the patient first and foremost but also for the other providers on scene AND in the hospital. We can all put our egos aside and remember that it's usually the patient that suffers when we focus too much on ourselves.
I hope you guys get something out of this episode. Please give me your feedback at Aaron@PracticalEMS.com.
Part 3, where we finish the discussion is live as well for PREMIUM members only. Check it out by subscribing as a premium member.
Subscriber-only episode
Premium member only episode.
Final part of our discussion surrounding scene etiquette. These guys have some great thoughts and I think you will find this valuable. Thanks for all the support guys!
Highlights from our scene etiquette part 1 episode. Don't forget to subscribe at PracticalEMS.com and check out the full episode on your favorite podcast player.
Thanks for checking out this new episode of Practical EMS. Don't forget to check out the video of this episode at PracticalEMS.com and subscribe to get updates on all new content, as well as receive the "How to Think Like an Emergency Physician" tip sheet PDF.
*In this episode I discuss scene management and etiquette with experienced Fire EMT Cody Thomson, Fire Paramedic Chris Valentine and Paramedic Vince Holditch.
These guys share some great thoughts about how to navigate these sometimes tricky scene interactions with crews and other responders. Honestly, I learned a lot that I wish I knew when I practiced as a full time paramedic.
Part 2 coming soon!*
In emergency medicine we use a top-down approach. What does the patient need? Not, what does the patient have?
4 Responsibilities of the Emergency Physician:
Resource stewardship - Not a lot of control over this variable
Customer service - Evidence based medicine doesn’t equal good customer service. You must be able to communicate well with your patients and manage expectations appropriately.
Symptom relief - Don’t forget to address the pain or symptom that the patient came in for while thinking through DDX and orders.
Patient safety - Most of our time is spent here.
Patient safety is resuscitation and identifying dangerous conditions
Dr. Strayers system:
Identify patients needing resuscitation and triage appropriately
Identify dangerous conditions using HPI, physical exam, testing. This list is narrowed down by each step in the process.
Have a plan for a negative workup as a positive work up will usually dictate a plan on its own.
Run the board frequently and after seeing new patients.
Place orders before charting
Manage interruptions with a method that works for you. Multitasking isn’t possible.
Expand work up if the HPI and physical exam are limited.
Huge thanks to Reuben Strayer! Check out his website EMUpdates.com
Thank you to Reuben Strayer for allowing me to reproduce his awesome content here. Check out his website at emupdates – return if worse for more emergency medicine content. Email me with comments or questions at Aaron@PracticalEMS.comQuick tips:
Resuscitation
Does the patient need resuscitation?
- Vitals
- AMS
-Neuro deficits
- Sick appearing
- Threat to self or others
Prioritize patient appropriately and/or call for appropriate resources
Identifying dangerous conditions- This is most of our ED patients
- Review RN/triage notes before seeing patient
- Prior visits/discharge summaries/ems runsheet
- Ask "What medical problems are you known for?"
- Ask for changes in medications
- Med non-compliance
- Social questions
- Ask last "Why have you come to the ED on this fine evening?"
- Have you ever had these symptoms before?
- Plan: what else need to be ruled out with imaging/lab work?
- Plan on what will happen with negative results, before they come back
- Positive results will usually dictate the plan
Run your board frequently- What are we waiting on?
- Patient improving or getting worse
- Should I offer update, food, pain meds
- Update charting
- Always place orders before charting
**Find a method for managing interruptions that works for you
If HPI and physical exam are difficult or limited - expand your work up
Don't make waste basket diagnosis such as costochondritis, gastroenteritis, GERD, anxiety
Follow key cases**
Brian and I discuss our experiences as a paramedic in PA school. Check out the full video at PracticalEMS.com or on YouTube @ PracticalEMS.
I discuss the misconceptions I once held when I was a full time paramedic about the PA profession. Don't let them become excuses for not pursuing the PA career path.
Full video at PracticalEMS.com or on YouTube @ PracticalEMS.
I discuss my reason for creating this podcast and I cover 10 of the biggest mistakes that I hear paramedics and Emt's make in their hand off reports. Full video at PracticalEMS.com or on YouTube @ PracticalEMS.
This episode comes from Reuben Strayers awesome video he put out years ago and has given me permission to reproduce.
My hope is that it will help you better understand the role we play in emergency medicine. Whether you are a paramedic, EMT, RN or EM APP, I think you will gain some real insight from his ideas. And if you are an experienced provider already, it may just help clarify some things about what you are already doing.
As always check out all my social media pages and YouTube channel @ PracticalEMS as well as my website PracticalEMS.com
Feedback is welcome at Aaron@practicalEMS.com and please check out Reuben Strayers website EMUpdates.com
Casey Shifflet, a well-respected and very experienced paramedic, and I discuss how to overcome burnout in EMS.
Full video on PracticalEMS.com or on YouTube @ PracticalEMS.
Please reach out to Casey or myself if you want to talk about burnout or your current struggles in EMS. We would be happy to talk with you.
Casey Shifflet: mcgoosh@gmail.com
Aaron: Aaron@practicalems.com