Practical EMS

133 | Dr. Julie | The Golden Rule in the ER | Skills, Humility, and Not Letting Others Break You

Sun, 21 Dec 2025 09:00:00 -0700

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

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 EMS earn 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

132 | Surviving the ER Without Losing Yourself — Dr. Julie on Burnout, Purpose and How we interact with EMS

Sun, 14 Dec 2025 09:00:00 -0700

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

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

131 | Women in the ER: Dr. Julie on Career Longevity and Burnout

Sun, 07 Dec 2025 09:00:00 -0700

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

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

130 | Dr. Brian | Faith at Work: Healing, Dying, and Being on the Other Side of the Hospital Bed

Sun, 30 Nov 2025 07:00:00 -0700

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

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

129 | Dr. Brian | The Metric of Mercy: Seeing Jesus in Every Patient

Sun, 23 Nov 2025 07:00:00 -0700

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

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

128 | Dr. Brian | When the Dopamine Fades: Staying Driven in Emergency Medicine

Sun, 16 Nov 2025 07:00:00 -0700

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

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

127 | ER Dr. Adam | Embrace the hard stuff | Being mentally present | Moving forward after a hard shift

Sun, 09 Nov 2025 07:00:00 -0700

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

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

126 | ER Dr. Adam | Faith and burnout | Choosing hard things | The reward in striving

Sun, 02 Nov 2025 06:00:00 -0700

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

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

125 | ER Dr. Adam | Former paramedic | Refocusing on your purpose | Faith in emergency medicine

Sun, 26 Oct 2025 07:00:00 -0600

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

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

124 | Josh with Crisis Prevention | The situations that burn out staff and make them leave the ER | Seek to understand, not win | Avoiding cynicism

Sun, 19 Oct 2025 07:00:00 -0600

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

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

123 | Josh with Crisis Prevention | Code Grey | Safety in the ER | The unmet want or need

Sun, 12 Oct 2025 07:00:00 -0600

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

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

122 | ER Dr. Lucas | Is it still worth becoming a physician? | Honor to being there on someone’s worst day | Don’t just do something, stand there

Sun, 05 Oct 2025 07:00:00 -0600

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

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

121 | ER Dr. Lucas | Longevity | Advice for the new ER physician | The lone wolf dies so stop putting off focus on community

Sun, 28 Sep 2025 07:00:00 -0600

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

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

120 | ER Dr. Lucas | Inevitable burnout | Gratitude | Being intentional about the positive

Sun, 21 Sep 2025 07:00:00 -0600

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

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

119 | Emergency Standards | Leave work at work | Take care of yourself before you take care of others

Sun, 14 Sep 2025 07:00:00 -0600

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 is not selfish—it makes you a better provider, coworker, and family member.
o“Treat yourself like someone you are responsible for helping” (Jordan Peterson).
oSupport coworkers’ wellbeing, too, to improve team effectiveness.
•Family and personal stories:
oGrandfather ignored health → massive stroke left him debilitated.
oShows consequences of postponing self-care.
•Longevity in emergency medicine (and life):
oSelf-care prevents burnout, depression, and chronic health issues.
oEmergencies will come eventually—better to prevent them by acting early.
oDaily discipline (waking early, working out, eating well, quality sleep) stacks the odds in your favor.
•Takeaway for all professions and parents:
oNo matter your job, putting yourself first makes you more effective at everything else.
oFor parents: wake before kids, establish morning rituals, and protect personal energy.
oSleep hygiene is critical: avoid late-night eating, screens, and poor routines.

Support the show

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

118 | Emergency Standards | Introduction | Do not seek to diagnosis

Sun, 07 Sep 2025 07:00:00 -0600

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 procedures.
- Some patients fixate on benign diagnoses, making them part of their identity.
Mental health & somatic symptoms: stress and anxiety often manifest as physical complaints.
Pain: highly subjective, influenced by mental state, overtreated in past (opioid epidemic).
Personal example: compulsive handwashing → overcame by focusing on behavior change, not labeling with OCD.
Broader life application:
- Don’t wait for full answers before acting.
- Avoid “paralysis by analysis.”
- Focus on solutions, not labels.
- Don’t let diagnoses—or any label—define your identity.
Closing lesson: In medicine and life, success comes from action and problem-solving, not obsessing over labels or perfect explanations.

Support the show

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

117 | Unique ER roles | Advice for newbies | Ways to get introduced to the world of medicine

Sun, 31 Aug 2025 07:00:00 -0600

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

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

116 | Unique roles in the ER | EKG tech and scribe | How to avoid burnout

Sun, 24 Aug 2025 07:00:00 -0600

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

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

115 | EKG tech and scribe role in the ED | Communication and teamwork

Sun, 17 Aug 2025 07:00:00 -0600

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

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

114 | Dr. David Berry | From homeless and addicted to chief of staff | Brain nerve connection and addiction | How to rewire the brain | Addiction stigma | Meth abuse

Sun, 10 Aug 2025 07:00:00 -0600

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 organization in Denver, CO that is working on new treatments for addictions and help market treatment centers and help get people to the treatment centers

Ibogaine helps to rewire the brain and is being studied to help with addiction

Dr. Berry’s mission is to share his story to reduce the sigma surrounding addiction and fear around dealing with the problem – there is hope, you can change your life. You can find redemption

David talks about his faith and how his trust in God played a key role in overcoming his addiction

David talks about how people make the argument “How could there be a God with all the evil in the world?” but he flips the argument to “How can there not be a God with all the evil in the world?”

There is only evil because God has given us a sense of right and wrong

We see evil in emergency medicine, but its presence means there must be the opposite, there must be light

Support the show

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

113 | Dr. David Berry | The ER doctor who overcame opiate addiction | How to care for the addicted and psychiatric patient with empathy

Sun, 03 Aug 2025 07:00:00 -0600

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

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

112 | Dr. David Berry | The ER doctor who lost everything | Overcoming alcohol and opiate addiction | Helping our patients recover

Sun, 27 Jul 2025 07:00:00 -0600

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 disorder, so avoiding labels is probably best in the ED

Have a way to work up patients that avoids your bias that may prevent objectivity

Support the show

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

111 | Michelle Niemeyer | Moving away from practicing law | Work life balance is bulls**t | Building community | Avoiding burnout | Getting clarity

Sun, 20 Jul 2025 07:00:00 -0600

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

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

110 | Michelle Niemeyer | The art of bending time | Learning to be in the moment | Burnout | What is keeping you from being fulfilled?

Sun, 13 Jul 2025 07:00:00 -0600

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

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

109 | Dr. Emma Jones | The Phoenix Blueprint and burnout | Emotional boundaries with patients | Quickly developing rapport | Unconditional positive regard | When you should be advocating for change

Sun, 06 Jul 2025 07:00:00 -0600

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

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

108 | Dr. Emma Jones | The Phoenix Blueprint and burnout | Emerging Stronger from the Blaze of Healthcare | Core values | Questioning your thoughts | Circle of control vs circle of concern

Sun, 29 Jun 2025 07:00:00 -0600

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 example, you can control your feelings but not someone else’s

Support the show

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

107 | Bryan Jepson MD, CFP | Good debt and bad debt | Debt pay down methods | The 4% rule | Is whole life insurance a good idea?

Sun, 22 Jun 2025 07:00:00 -0600

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

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

106 | Bryan Jepson | EM physician and financial planner | Living rich vs living wealthy | Attributes for financial success

Sun, 15 Jun 2025 07:00:00 -0600

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 what you value, if you value cars this might be something that brings you enough joy to be worth the money

It’s not that you can’t buy nice stuff, but you should avoid going into debt to do it

Support the show

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

105 | Sick vs not sick | Should we trust our gestalt | Bias affecting care | Advice for the newbie RN, EMT, paramedic, PA | Running 3 gunshot wounds in one night

Sun, 08 Jun 2025 07:00:00 -0600

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

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

104 | Conflict in the ED | Covid times | Long careers without burning out | Using what you do to define your identity | Limits to empathy |How do we solve interpersonal conflict in the ED?

Sun, 01 Jun 2025 07:00:00 -0600

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

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

103 | Sensitive hand-off reports | Paramedic role in the ED | Conflict on scenes | Remembering why you got into medicine in the first place

Sun, 25 May 2025 07:00:00 -0600

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

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

102 | Giving report to the ED | RN workload vs paramedic workload | Why won’t the ED use your IV’s?

Sun, 18 May 2025 07:00:00 -0600

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

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

101| Arriving first on scene | Big personalities taking over calls | Respect for the ambulance as our office | Fire crews riding in the ambulance | Transporting after reversing hypoglycemia or opiate OD

Sun, 11 May 2025 07:00:00 -0600

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

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

100 | Fire vs ambulance on scenes | How can we get along | Trauma bonding | How to work in EMS long-term | PTSD in EMS | Burnout vs moral injury | Covid affects on EMS

Sun, 04 May 2025 07:00:00 -0600

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 the trenches of a difficult call with other people, it connects you

Disagreements are going to happen so they are important to address so you can avoid a problem on the subsequent call

How does the fire officer solve these disagreements between paramedics? John says he takes the paramedics aside, to a private location to allow them to talk – this has always allowed them to come to a consensus and go back to the call as a team

Jason talks about doing the productive thing rather than venting – have a conversation

John stresses that we are all on the same team, team patient

Kash talks about the dangers of jousting in the medical reports (trying to make another provider look poorly and make it obvious you disagreed with them) - it shows a non-cohesive team and therefore compromised judgement regarding patient care and casts doubt on the entire care team

Support the show

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

99 | Giving a good ER hand-off report | Unexpected retirement from the fire department | “What is the worst thing you have ever seen?” | Dealing with tragedy in the ER vs the field

Sun, 27 Apr 2025 07:00:00 -0600

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

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

98 | Fire paramedics and medical director panel | Assessing capacity | Suicidal patients | Involving medical control

Sun, 20 Apr 2025 07:00:00 -0600

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

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

97 | Drs. Sean and Adam | Difficult admissions | What admissions do and do not accomplish | Group culture | Obs vs in-patient status | How we can help the hospitalist from the ED

Sun, 13 Apr 2025 07:00:00 -0600

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

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

96 | Drs. Sean and Adam | EM vs IM | Admitting the weak elderly patient | Workflow as a hospitalist | Consulting a hospitalist

Sun, 06 Apr 2025 07:00:00 -0600

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

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

95 | Drs. Sean and Adam | Emergency medicine vs Internal Medicine | Mindset differences | Good storytelling | Advice on admission requests

Sun, 30 Mar 2025 07:00:00 -0600

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

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

94 | Eddie opens up about his deepest struggles in EMS | Retiring from EMS | Lossing partners | Advice for newbies

Sun, 23 Mar 2025 07:00:00 -0600

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

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

93 | Old school paramedics Casey and Eddie | I’m not doing it for the pay | The Privilege we have | Working in the ED as a paramedic

Sun, 16 Mar 2025 07:00:00 -0600

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

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

92 | Eddie and Casey | Good EMT partners | Calls that damage you | Remembering the bad calls over the good | Effects of a career in EMS

Sun, 09 Mar 2025 08:00:00 -0600

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

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

91 | Old school paramedics Eddie and Casey | Is EMS just a steppingstone | For some it’s a job, for some it’s a life

Sun, 02 Mar 2025 07:00:00 -0700

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

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

90 | Doing difficult things makes you stronger | Pain of getting well is sometimes greater than the pain of staying stuck | Is emergency medicine your purpose

Sun, 23 Feb 2025 07:00:00 -0700

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

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

89 | Death and dying | Pastor Daniel Grothe | Non-anxious presence | Emotional whiplash | Habits to hit the reset button

Sun, 16 Feb 2025 07:00:00 -0700

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

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

88 | Death and Dying in emergency medicine | Pastor Daniel Grothe | New panel | Burnout comradery

Sun, 09 Feb 2025 07:00:00 -0700

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

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

87 | Kevin Hazzard | American Sirens | The great story of Freedom House and EMS origins | The good Samaritan | Early emphasis on intubation

Sun, 02 Feb 2025 07:00:00 -0700

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

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

86 | Kevin Hazzard | Missing EMS | American Sirens | Chaotic scenes | Early paramedic John goes from cleaning hospital rooms to intubating critical patients

Sun, 26 Jan 2025 07:00:00 -0700

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

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

85 | Kevin Hazzard | Being an EMT tourist | Paragod phase | Moving on from EMS | A Thousand Naked Strangers

Sun, 19 Jan 2025 07:00:00 -0700

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

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

84 | Kevin Hazzard | A Thousand Naked Strangers | Writing for film/TV | EMT school process

Sun, 12 Jan 2025 07:00:00 -0700

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

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

83 | Is medicine your entire personality? | Get off on time | Burnout | Compassion fatigue | A physicians personal experience with the ER

Sun, 05 Jan 2025 07:00:00 -0700

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

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

82 | Getting comfortable saying “I don’t know” | Advice for newbies | Learning from those lower than you on the perceived hierarchy

Sun, 29 Dec 2024 07:00:00 -0700

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

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

81 | New panel | Charge RN advice | Physician efficiency tips | Developing Confidence

Sun, 22 Dec 2024 07:00:00 -0700

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 really affects the nurse’s ability to be efficient as well

Do complicated procedures the same way every time

We teach this with intubation was well- have everything set up the same way every time with all your back ups, so you increase your chances of success

Confidence comes with time, but it is something you should be working on as well. Not arrogance.

Second guessing will make you less efficient

Plan on a negative work up because a positive result will usually dictate the plan

Think one step ahead. After you see a patient have an idea of what you are going to do.

Pre-discharge patients when you have a chance. Write the scripts, put in the follow up. Give the discharge instructions.

Support the show

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

80 | Lori Hodges Part 2 | Author | Paramedic | Emergency Manager

Sun, 15 Dec 2024 07:00:00 -0700

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 intentionally found in a disaster or crisis or the overwhelming negatives are all you will focus on

Collateral beauty is the community coming together after a crisis

Lori talks about some very difficult health struggles she has had including a large mass in her chest. She has had to face her own mortality. She chooses not to identify with the problem. She allows herself 24 hours to feel bad but then she moves on and chooses to not be defined by the problem and live a life that is worthy

Lori talks about how emergency management is a different career than being a paramedic in more ways than one

It is more of a collaboration than a command-and-control model but there are advantages that paramedics have to bring the career

Emergency management is not a retirement job

PA is also not a retirement job for paramedics. Not that it isn’t helpful to be a paramedic first, but it is a whole new career

Lori explains tactical vs strategic decisions in emergency management

Lori talks about Hurricane Milton management

Collateral beauty in post hurricane Milton was seen by Lori when she saw the systems working together to repair the damage&nb

Support the show

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

79 | Lori Hodges Part 1 | Author | Paramedic | Emergency Manager

Sun, 08 Dec 2024 07:00:00 -0700

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 us to see the beauty after the chaos. The good in the bad. You must be intentional about seeing the good or the job will burn you out

It is very easy to only concentrate on the bad, but you will miss the good sides of humanity if you aren’t looking for it

Lori talks about a dying cancer patient and how she remembers the transport because of the meaningful conversation she had with the patient about her life not because of a high-level skill or clinical judgment

We need to change the way we measure success in EMT from high level skills and high acuity calls to impactful moments

When I was an EMT I feel like I was able to better focus on the meaningful moments with patients since I wasn’t focused on differentials or skills

Lori talks about seeing the beauty in disaster, we must look for the good

I describe it as horrible beauty

Support the show

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

78 | Kelly Grayson Part 2 | Author | Blogger | Paramedic

Sun, 01 Dec 2024 07:00:00 -0700

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 marriage

Also, remember that we may not be that many steps removed from some of these addicts, alcoholics and homeless. Have some sympathy for them

We all have our struggles and some of them are worse than others

The term hero gets thrown around a lot but a lot of us don’t like to think of ourselves as heroes

But when a patient tells you that you are a hero, maybe then we can accept it

What is important to us is not what is important to the patient

Were you nice?

We don’t know what the patient is going through. It’s helpful to have a paradigm shift and realize that they are likely having one of the worst days of their lives

No one cares how much you know until they know how much you care

Support the show

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

77 | Kelly Grayson Part 1 | Author | Blogger | Paramedic

Sun, 24 Nov 2024 07:00:00 -0700

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

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

76 | Difficult intubation | Advice for newbies | Don’t blame patients | Your happiness is up to you | Event horizons on calls

Sun, 17 Nov 2024 07:00:00 -0700

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

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

75 | We can’t choose what affects us | Teamwork on scenes | Recognizing you need help | Responding with anger

Sun, 10 Nov 2024 07:00:00 -0700

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

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

74 | Burning out on EMS | Sleep deprivation | Raging at dispatch | Daily micro-traumas

Sun, 03 Nov 2024 06:00:00 -0700

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

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

73 | New panel! | EMS to law enforcement | The lesson from the spine board

Sun, 27 Oct 2024 07:00:00 -0600

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

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

72 | Nate’s off-duty call | That human connection | Moral injury vs burnout | Newbie advice

Sun, 20 Oct 2024 07:00:00 -0600

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

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

71 | Rapid sequence intubation changes | How crews can make or break an EMT student’s experience | How those hard calls affect us | Casey talks about the impression he made on a family

Sun, 13 Oct 2024 07:00:00 -0600

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

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

70 | Why the big scope differences across state lines | Case review purpose | Teaching the newbies

Sun, 06 Oct 2024 07:00:00 -0600

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

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

69 | New panel! Why emergency medicine | Don’t just do something, stand there | Being proud of what you do

Sun, 29 Sep 2024 07:00:00 -0600

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

Support the show

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

#68 - Over-reliance on technology, standards for students, don't listen to naysayers, advice for newbies

Sun, 22 Sep 2024 06:00:00 -0600

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

Support the show

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

#67 - Burnout avoidance, decision fatigue, driving lights and sirens, Where is God in emergency medicine?

Sun, 15 Sep 2024 06:00:00 -0600

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

Support the show

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

#66 - Paramedics getting offended, first code as a medical student, making a human connection and measuring success in EMS

Sun, 08 Sep 2024 06:00:00 -0600

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.

Support the show

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

New panel, power in detaching, controlled drowning, overwhelm as a new provider

Sun, 01 Sep 2024 06:00:00 -0600

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

Support the show

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

Overcoming burnout, having purpose, showing grace for patients while also having healthy boundaries

Sun, 25 Aug 2024 06:00:00 -0600

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

Support the show

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

The Dunning-Kruger effect, building confidence, the importance of knowing the "why", when to do nothing

Sun, 18 Aug 2024 06:00:00 -0600

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.

Support the show

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

Stress exposure in school, zero to hero, advocating for patients

Sun, 11 Aug 2024 00:00:00 -0600

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

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

Only medical provider on a plane, swatting flies in the back of an ambulance, paramedic program changes

Sun, 04 Aug 2024 06:00:00 -0600

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

Support the show

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

Foley buddies and no no zones

Sun, 28 Jul 2024 06:00:00 -0600

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

Support the show

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

Nate's overdose and recovery

Sun, 21 Jul 2024 06:00:00 -0600

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.

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

Support the show

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

Caring for a gunshot victim when trying to get coffee

Sun, 14 Jul 2024 06:00:00 -0600

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

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

Support the show

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

Resilient Response: Self-Care Strategies for Emergency Medicine Part 2

Sun, 07 Jul 2024 06:00:00 -0600

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

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

Resilient Response: Self-Care Strategies for Emergency Medicine Part 1

Sun, 30 Jun 2024 06:00:00 -0600