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

Ross Orpet, Paramedic turned EMS Physician

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

  1. 1d ago

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

    Burn patients can create a disproportionate amount of anxiety. The calls are uncommon, the injuries can be visually overwhelming, and it is easy to get distracted by the burn itself. Ross and Will talk with Mark Johnston, a longtime Advanced Burn Life Support instructor and burn program leader at Regions Hospital, about simplifying prehospital burn care. Mark explains how most burn patients should be approached and why you need to resist the urge to make wound care the first priority. They also dig into the findings that should make you truly concerned about an inhalation injury, how to estimate total body surface area, and which smaller burns still warrant burn-center evaluation. In this episode, you’ll learn: Which airway findings increase concern for inhalation injury Why the simple 125/250/500 mL-per-hour approach can be more useful in the field than calculating a full Parkland formula How mechanism changes your priorities in thermal, chemical, electrical, and enclosed-space burns How wet dressings and aggressive wound care can increase heat loss or distract clinicians from early interventions   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August. The Emergency Mind: Wiring Your Brain for Performance Under Pressure, by Dan Dworkis, MD PhD Peak Performance Under Pressure, by Stephen Hearns Episode 109: Understanding the EMS Power Curve Guests: Mark Johnston, BSN, RN, TCRN, Burn Program Manager at Regions Hospital

  2. Aug 17

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

    Readiness is about more than knowing the medicine. It’s about creating the conditions for patients, families, and clinicians to feel safer and more capable when the situation is unfamiliar, overwhelming, or high risk. First up, Boston MedFlight flight nurse Nicole King discusses neurodivergence, sensory overload, and how traditional EMS behaviors can unintentionally escalate distress. She explains why slowing down, reducing stimuli, and involving caregivers can completely change the experience for patients who are struggling. Then, Ross talks with pediatric flight nurse and Blakery Content creator Christopher Blake about pediatric readiness and why confidence on low-frequency, high-risk calls has to be built before the tones drop. They discuss pediatric emergency care coordinators, agency-wide readiness, and using QA/QI. In this episode, you’ll learn: How to recognize when behavior may be the result of sensory overload or difficulty processing the environment Why pictograms, fidget toys, headphones, sunglasses, and weighted pressure can reduce escalation  How a Pediatric Emergency Care Coordinator can help an agency identify gaps Why family-centered communication can reduce fear and improve cooperation How to adapt your assessment when a patient cannot tolerate standard vital-sign monitoring    Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August.   Pediatric Readiness Assessment KultureCity Ben’s Blue Bags and Carter Kits Emergency Medical Services for Children Innovation & Improvement Center Birth Vibes: Stories & Strategies for An Empowered Birth, by Jen Hamilton Guests: Nicole King, flight nurse, Boston MedFlight Christopher Blake, pediatric flight nurse and creator of Blakery Content

  3. Aug 10

    Heat Stroke: Recognition, Cooling, and Transport Decisions

    What differentiates heat stroke from heat exhaustion? Once central nervous system dysfunction appears, every minute spent at an elevated core temperature increases the risk of permanent neurologic injury or death. Ross and Will talk with emergency physician and wilderness medicine specialist Dr. Greg Doctor about the full spectrum of heat-related illness – from heat cramps, rash, and edema to syncope, exhaustion, and life-threatening heat stroke. They discuss how to avoid anchoring on the heat when a patient loses consciousness and what the critical dividing line between heat exhaustion and heat stroke is. They also examine exercise-associated hyponatremia, drug-related hyperthermia, fluid selection, and the patients who may remain at risk even after they initially appear to recover. In this episode, you’ll learn: How to distinguish heat syncope, heat exhaustion, and heat stroke Why central nervous system dysfunction and an elevated core temperature matter most How to choose between cold-water immersion, continuous water and fanning, ice sheets, and ice-water slurry techniques When transport should be delayed for on-scene cooling, and when cooling should continue   Resources: Wilderness Medical Society Clinical Practice Guidelines for the Prevention & Treatment of Heat Illness: 2024 Update Unlocking Syncope with Matt Mendes The Critical Care of the Sick Runner: A Comprehensive Guide with Dr. Whitney Barrett Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August. Guests: Dr. Greg Doctor, emergency physician and wilderness medicine specialist

  4. Aug 3

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

    Most people picture a master clinician as the person in the room who knows every answer. In reality, mastery looks like the opposite, and admitting what you do not know. Ross talks with FlightBridgeED co-founder Eric Bauer about the “rage to mastery”, the advice that kept him in EMS after a series of difficult calls nearly drove him away, why expertise is perishable, and how ego creates resistance to learning. Then, Will speaks to Master Your Medics founder Geoff Murphy about a medication error that changed how Geoff understood team culture. They explore what happened, and why psychological safety does not lower the standard.   In this episode, you’ll learn: Why sustainable learning habits are more valuable than ambitious goals How experienced clinicians can model vulnerability without undermining their credibility What to look for in a mentor who will challenge blind spots  How to turn an uncomfortable call into action-oriented preparation for the next patient   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off through the end of August. Guests: Eric Bauer, CEO and Co-Founder of FlightBridgeED Geoff Murphy, Founder and Lead Educator of Master Your Medics

  5. Jul 27

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

    The calls that scare clinicians the most are often the ones they have the fewest opportunities to practice. So what happens during a rare, high consequence emergency? First, Jennifer Barnhart of Austin-Travis County EMS and Sergeant Luke Serrato of the Austin Police Department discuss the response to a mass casualty shooting on Austin’s Sixth Street. Then, Ross talks with Allen Wolfe about three unusual burn and blast-injury cases. They discuss when a smaller burn may still warrant transfer to a burn center, how to recognize an airway that may require an early surgical approach, what a blast mechanism can reveal about hidden injuries, and why protecting burned tissue cannot come at the expense of protecting the airway. In this episode, you’ll learn: How shared language and closed-loop communication help EMS and law enforcement move together  Why responders may need to pass ambulatory or vocal patients to reach those who cannot self-rescue What disrupted tympanic membranes, clothing patterns, circumferential facial burns can reveal   Resources: Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off and a chance to win a free subscription. Enter before August 1, 2026.   Guests: Jennifer Barnhart, Clinical Specialist, Austin-Travis County EMS Sergeant Luke Serrato, Austin Police Department Allen Wolfe, Senior Director of Clinical Education and Clinical Nurse Specialist at Life Link III

  6. Jul 20

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

    The hardest part of evidence-based medicine is not finding a paper. It is deciding whether that paper should change what you do on your next shift. First, we talk with Dr. Jeff Jarvis about how to evaluate medical literature beyond the headline, abstract, conclusion, or p-value. You’ll hear about the PICO framework and why patient-oriented outcomes should matter more than the numbers that are easiest to measure. Then, Ross talks with emergency physician Dr. Ben Abo about the evidence surrounding rigid cervical collars. He also shares how his EMS system removed collars from its ambulances by involving trauma surgeons, neurosurgeons, emergency clinicians, and frontline providers in the change. In this episode, you’ll learn: How to use population, intervention or exposure, comparison, and outcome to decide whether a study applies to the patients you actually treat Why return of spontaneous circulation, p-values, and national benchmarks can distract clinicians from the outcomes patients care about most What the literature suggests about cervical collars, spinal cord perfusion, airway compromise, aspiration risk, intracranial pressure, and pressure injuries How to bring research to a medical director and change a long-standing protocol    Resources: NAEMSP Trauma Compendium: Prehospital Management of Spinal Cord Injuries Want more? Sign up for our weekly newsletter, The Confidence Dispatch. Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship. Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off and a chance to win a free subscription. Enter before August 1, 2026.   Guests: Dr. Jeff Jarvis, MD, MS, EMT-P Dr. Ben Abo, DO, EMT-P Guest Host: Matt Hedlun, Battalion Chief of Education at Thompson Valley EMS

  7. Jul 13

    The Three Building Blocks of Trust in EMS

    Trust is the architecture behind every patient interaction you run. Dr. Cory Scheer, author of Closing the Trust Gap, has identified three evidence-based building blocks of trust: competency, problem-solving, and care for others. It turns out EMS providers already use all three the moment they step on scene. In this episode, we unpack the gap between senior leaders and frontline EMS workers, what your "trust signature" reveals about how you naturally lead, and why imposter syndrome might be a signal worth listening to instead of pushing through. Book a Free Coaching Call · Sign up for the weekly newsletter ·  Check out The Loud & Clear Fellowship program.

  8. Jun 29

    The Skill Is Not The Hard Part

    The hardest part of a bad call is rarely the algorithm. In two different interviews I explore some human traps of running an EMS call. I talk with Danny and Rance from DNR Prehospital Education about a choking arrest, a difficult field intubation, and the trainer-trainee dynamic that made the call more complicated than the procedure itself. Then Bobby breaks down the CAFE pneumonic of heuristic traps: commitment, acceptance, familiarity, and expert halo. This episode moves from the protocol and algorithm to the human challenges of running. Want more? Sign up for our weekly newsletter The Confidence Dispatch Want individualized coaching and mentorship? Check out The Loud & Clear Fellowship Just have a question and want some personalized help? Book a free coaching call with us. Interested in ABLS Now? Our listeners get 10% off and a chance to win a free subscription (giveaway on July 1st, 2026).

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

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