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. 6D AGO

    Suction First: Dr. DuCanto on the SALAD Technique for the Contaminated Airway and What Comes Next

    The contaminated airway is one of the most unforgiving calls in prehospital medicine. Blood, vomit, debris — your laryngoscope goes in and you're blind. For decades, paramedics managed this with tools designed for a clean OR and training that never got close to the real thing. Dr. Jim DuCanto decided that was unacceptable. He's the anesthesiologist who invented the DuCanto catheter and SALAD (Suction Assisted Laryngoscopy and Airway Decontamination). Will Berry sat down with Dr. DuCanto at the FASTCAN conference for a conversation. In this episode we cover: - The SALAD technique, step by step - Why paramedic OR training should default to video laryngoscopy - The downsides of SALAD that Dr. DuCanto himself will tell you about - What a new portable suction device does differently Guest: Dr. Jim DuCanto anesthesiologist, inventor of the DuCanto catheter and the SALAD technique   Want more? Also subscribe to The Confidence Dispatch — Our free weekly newsletter for paramedics who want to get 1% better every shift: → https://loudandclear.kit.com/d45b012fae   Want to go even further? The Paramedic Confidence Builder is a year-long course and coaching community for medics who want to close the gap between what school taught them and what the job actually demands.  Not a lecture series. Not another CE you'll forget by your next shift. Real frameworks for clinical reasoning and mental performance — the stuff nobody teaches you in school. If that sounds like what you've been looking for, book a free 30-minute call and we'll talk about whether it's the right fit: → calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder

    30 min

  2. FEB 25

    Wired to Fail: The Science of Human Error in EMS

    What if the mistake wasn't your fault... but it's still your responsibility? That's the tension Shay Montgomery sits with every time she talks about the day she flew to a scene without the drug bag. Shay is a flight nurse and educator. At FAST 25, she gave one of the sharpest talks of the conference — not on a procedure or a drug, but on the science of why humans make mistakes and what we can actually do about it. WHAT YOU'LL LEARN: Task Brackets — Your brain bundles repetitive actions into smooth automated sequences. The First Habit Rule — The first habit is permanently ingrained. Old habits lurk underneath new ones and surface under stress. Get it right the first time. Goal-Oriented Stimulus — Don't ask "Do I have everything?" Ask "Where are the things I need?" and physically point to them. The Preceptor Problem — Most preceptors feel unprepared. The goal isn't to make "mini me", it's to create independent critical thinkers. Shift Fatigue — Cognitive function degrades meaningfully at 16 hours. Just Culture — Human error is inevitable. Punishment doesn't fix the system. The guilty already feel terrible. They need peer support and system redesign.   RESOURCES: Join our Paramedic Confidence Builder    CONNECT WITH US: - Instagram- @emsloudandclear - YouTube- https://www.youtube.com/@EMSLoudandClear - Website- www.emspodcast.com    CONNECT WITH SHEA: - TikTok: @flightnurseshay - Instagram: @flightnurseshay

    11 min

  3. FEB 9

    Dump Kits and Checklists: Why Expert Paramedics Still Crash

    Miss your first intubation attempt and your patient's risk of adverse events jumps sevenfold. By the third attempt? Nearly guaranteed complications. This isn't about your anatomical knowledge or practice hours—expert clinicians fail too. David Olvera, who led national research on intubation checklists, reveals why your brain predictably fails under pressure and what systems actually prevent it. You'll learn the challenge-response checklist protocol that speeds up your intubation time (not slows it down), the HEAVEN criteria's six specific warning signs that predict difficult airways before you attempt, and why dump kits create muscle memory that works in the dark. David shares the story that started his human factors obsession and proves that expertise doesn't protect you from error—systems do. This is operational excellence: building checklists that think for you when tunnel vision sets in.   Want more? Also subscribe to The Confidence Dispatch — Our free weekly newsletter for paramedics who want to get 1% better every shift: → https://loudandclear.kit.com/d45b012fae Want to go even further? The Paramedic Confidence Builder is a year-long course and coaching community for new medics who want to close the gap between what school taught them and what the job actually demands. Built by an ER doc who runs medical direction for 5 rural Colorado agencies and has talked with hundreds of paramedics about exactly where that gap shows up. Not a lecture series. Not another CE you'll forget by your next shift. Real frameworks for clinical reasoning and mental performance — the stuff nobody teaches you in school. If that sounds like what you've been looking for, book a free 30-minute call and we'll talk about whether it's the right fit: → calendly.com/d/cq38-87r-fkk/paramedic-confidence-builder Resources   Paramedic Confidence Builder - emspodcast.com/program  To see the actual checklist - https://www.airmedandrescue.com/latest/long-read/medical-insight-latest-tools-ensure-successful-first-pass-intubation    Guest/Cast/Crew information- Guest- David Olvera Host- Ross Orpet, Will Berry    Catch up with us after the show - Instagram- @emsloudandclear - YouTube- https://www.youtube.com/@EMSLoudandClear - Website- www.emspodcast.com   Books we recommend - The Dichotomy of Leadership - https://amzn.to/4fiCAjN - Extreme Ownership - https://amzn.to/3O1FWfa -  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf - Thinking Fast and Slow - https://amzn.to/4fiJG85   Gear We Like - Good Stethoscope - https://amzn.to/3YJJrf2 - Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  - Notepad for taking notes on calls - https://amzn.to/3Z1X21J

    18 min

  4. JAN 26

    Feeling Behind the Curve? Understanding the EMS Power Curve Will Help You Stay Ahead

    Behind the curve. We've all heard it. Most of us have lived it. That sinking feeling when you're mentally three steps behind where the call actually is. The concept of the Power Curve comes from aviation—pilots need to understand the phases of flight and how the plane will react differently and require different inputs during each of these phases. The same principle applies to your 911 calls. This episode breaks down the exact framework to chunk calls into five critical phases. When you understand phases you understand what is needed during each point of the call and how to stay ahead. How to build if-then statements that eliminate decision fatigue. The psychological safety that lets you reset after screwing up in the apartment. And why 80% of medical errors tie back to the one phase—the hospital handoff. Stop reverting to chaos. Build the system that keeps you ahead. Guest/Cast/Crew information- Guest- Moose and Josh from Alert Medic 1 podcast Host- Ross Orpet, Will Berry  Catch up with us after the show - Instagram- @emsloudandclear  YouTube- https://www.youtube.com/@EMSLoudandClear   Website- www.emspodcast.com Books we recommend - The Dichotomy of Leadership - https://amzn.to/4fiCAjN - Extreme Ownership - https://amzn.to/3O1FWfa -  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf - Thinking Fast and Slow - https://amzn.to/4fiJG85 Gear We Like - Good Stethoscope - https://amzn.to/3YJJrf2 - Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn    - Notepad for taking notes on calls - https://amzn.to/3Z1X21J

    1h 17m

  5. JAN 13

    Stupidity in EMS: The causes and remedies

    You're not making mistakes because you're dumb. You're making mistakes because of seven predictable factors—and once you know them, you can control them. Kris Kaull delivered a masterclass at FASTCAN on the hidden forces that cause even experienced paramedics to miss critical information when it matters most. This isn't about memorizing more protocols—it's about understanding the cognitive science behind high-stakes decision-making in emergency medicine.   Guest/Cast/Crew information- Guest- Kris Kaull, FP-C Host- Ross Orpet Catch up with us after the show - Instagram- @emsloudandclear  YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Books we recommend - The Dichotomy of Leadership - https://amzn.to/4fiCAjN - Extreme Ownership - https://amzn.to/3O1FWfa -  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf - Thinking Fast and Slow - https://amzn.to/4fiJG85 Gear We Like - Good Stethoscope - https://amzn.to/3YJJrf2 - Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn   - Notepad for taking notes on calls - https://amzn.to/3Z1X21J

    23 min

  6. 12/17/2025

    Anaphylaxis + Asthma: When Standard Anaphylaxis Treatment May Not Be Enough (AMAX4 Explained)

    This episode tells the tragic story of Max McKenzie, a teenager with asthma who died from anaphylaxis despite receiving "standard care." His death led his father, Dr. Ben McKenzie, to develop the AMAX4 algorithm. Educator and critical care transport nurse/paramedic Bruce Hoffman breaks down the algorithm and explains why the combination of anaphylaxis and asthma can be lethal, why IM epinephrine may not be enough, and why this is the time to be aggressive. But this isn't simply about memorizing another algorithm. It's about developing the operational confidence to recognize when standard approaches may fail and override your impulse to "try the book answer one more time." You'll learn to identify time-critical scenarios, build red-flag combination awareness, and make high-stakes decisions without second-guessing yourself.  Want to systematically build this decision-making confidence? Discover the Paramedic Confidence Builder at emspodcast.com/program —where we teach the operational skills your school didn't.   Guest/Cast/Crew information- Guest- Bruce Hoffman, Associate Professor, Critical Care RN and Paramedic Host- Ross Orpet, Will Berry  Catch up with us after the show Instagram- @emsloudandclear YouTube- https://www.youtube.com/@EMSLoudandClear Website- www.emspodcast.com Books we recommend The Dichotomy of Leadership - https://amzn.to/4fiCAjN Extreme Ownership - https://amzn.to/3O1FWfa  Managing the Unexpected: Sustained Performance in a Complex World -        https://amzn.to/3V7BwYf Thinking Fast and Slow - https://amzn.to/4fiJG85 A Thousand Naked Strangers: A Paramedic's Wild Ride to the Edge and Back -  https://amzn.to/3YJJrf2 Gear We Like Good Stethoscope - https://amzn.to/3YJJrf2 Good Shears - https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn  Notepad for taking notes on calls - https://amzn.to/3Z1X21J

    19 min

  7. 12/12/2025

    The Habit Loop: How Master EMS Clinicians Build Unconscious Competence Through Habits

    Struggling to remember every protocol in high-pressure medical situations? You're not alone—and memorizing everything isn't the answer.   Join us for this game-changing conversation with Jean Francois Couture, co-founder of Parys Medical, as we unpack the science of habit formation for EMS and healthcare providers. Recorded live at FAST 25, Jean breaks down the "habit loop" (cue, routine, reward) and introduces the concept of the "meta-habit"—a habit of habits that transforms how you access critical information during emergencies.   Learn why the best clinicians don't memorize everything but know exactly where to find what they need when seconds count. Discover practical strategies for mental simulation, protocol familiarization, and building muscle memory with your cheat sheets. Jean shares actionable steps including planning your clinical scenarios, scheduling regular practice sessions, and developing unconscious competence through repetition.   Whether you're new to EMS or a seasoned veteran, this episode provides a roadmap for achieving clinical excellence through deliberate practice and smart information management.   Ready to level up your clinical practice? Visit our website to learn more about our paramedic confidence builder course- https://emspodcast.com/program/

    16 min

  8. 12/03/2025

    Hypothermia Rescue: Cardiac Arrest in a Tree Well

    What happens when a 24-year-old woman is found frozen in a tree well after last being seen 8 hours prior, with a core temperature of 62°F (17°C)? In this extraordinary case, paramedic Miles Randell and his team performed 4 hours of CPR in knee-deep snow on April Fool's Day 2014—and she walked away with zero neurological deficits. This wasn't luck. Miles breaks down the critical decision to defy transport protocols and how they managed a failed field intubation when her torso sank into the snow during compressions. The case became a catalyst for building Teaam Aeromedical, a progressive nonprofit wilderness air ambulance saves time, lives, and healthcare dollars. Learn the physiology of hypothermic cardiac arrest, why less intervention is sometimes more, and how to package patients in snow to prevent further heat loss. Whether you work in wilderness medicine or urban EMS, the principles here apply: know the science, challenge protocols when they don't serve your patient, and get them to the right place at the right time. Interested in our Paramedic Confidence Builder course? Check us out at - emspodcast.com Guest/Cast/Crew information- Guest- Miles Randell, Paramedic, Founder of TEAAM Aeromedical, for more go to teaam.ca  Host- Ross Orpet   Catch up with us after the show - Instagram- @emsloudandclear - YouTube- https://www.youtube.com/@EMSLoudandClear - Website- www.emspodcast.com

    40 min
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About

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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