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. 3d ago

    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

  2. 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

  3. 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

  4. 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

  5. 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.

  6. 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).

  7. Jun 15

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

    A postpartum patient does not need to look dramatic to be in real danger. In this episode from FAST 26, Ross talks with Amy Loucks about pregnancy-related deaths, maternal care deserts, postpartum warning signs, hypertension, cardiomyopathy, infection, and the calls EMS can easily miss. Then Elizabeth Garchar walks through amniotic fluid embolism, now often framed as an anaphylactoid reaction of pregnancy: sudden cardiovascular collapse, right heart failure, DIC, TXA, whole blood, AOK, and the principle that matters most when everything goes bad: treat mom first.   Interested in the Loud & Clear Fellowship? Sign up for a free coaching call to learn more.    Sign up for a weekly newsletter The Confidence Dispatch for EMS performance tips delivered straight to your inbox.    Episode Resources- CDC: Preventing pregnancy-related deaths — https://www.cdc.gov/maternal-mortality/preventing-pregnancy-related-deaths/index.html Amniotic fluid embolism overview — https://my.clevelandclinic.org/health/diseases/15463-amniotic-fluid-embolism AOK regimen for amniotic fluid embolism — https://pmc.ncbi.nlm.nih.gov/articles/PMC9477128/   https://www.marchofdimes.org/peristats/ https://www.marchofdimes.org/research/maternity-care-deserts-report.aspx  https://saferbirth.org/  https://www.nmperinatalcollaborative.com/

  8. Jun 7

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

    Pre-Oxygenation is not just putting oxygen on the patient and hoping the sat buys you enough time. In this episode, Ross talks with Scott Weingart after his FAST26 talk on preventing peri-intubation arrest. They get into why many peri-intubation arrests are predictable and preventable, why shunt physiology requires pressure and not just FiO2, and how EMS clinicians can build a field-ready setup with a nasal cannula, BVM mask, PEEP valve, and continuous pressure. Scott also walks through low-, moderate-, and high-risk patients, why high-risk oxygenation patients may not be good RSI candidates, and what changes for asthma, aspiration risk, and morbid obesity. Book a FREE Coaching Call with Us Here Learn More About the Loud & Clear Fellowship American Burn Association ABLS Now giveaway and 10% listener discount PREOXI trial: Noninvasive Ventilation for Preoxygenation during Emergency Intubation PreVent trial: Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults EMS World Live + FAST 26 conference coverage Guest: Scott Weingart / EMCrit — https://emcrit.org/

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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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