Practical EMS

My mission is to use the stories we all have in emergency medicine to encourage and uplift you where you are. EMT, Paramedic, nurse, PA, NP or physician. Emergency medicine is a very difficult specialty with unique challenges, and it calls us all to be better than the average person in order to stay healthy for our patients, our families and own mental wellness. I want to connect with EMS crews, fire crews, ER RN's, ER techs and new ER advanced practice providers to better understand their current struggles. I also want to bridge the gap between prehospital medicine and the emergency department and to encourage those seeking to become an advanced practice provider. Disclaimer: All Practical EMS content is opinion only. It is unaffiliated with any company or organization and does not represent any company or organization that Aaron currently works for or has worked for in the past. No content should be taken as medical advice.

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Top 10 Practical EMS Episodes

Goodpods has curated a list of the 10 best Practical EMS episodes, ranked by the number of listens and likes each episode have garnered from our listeners. If you are listening to Practical EMS for the first time, there's no better place to start than with one of these standout episodes. If you are a fan of the show, vote for your favorite Practical EMS episode by adding your comments to the episode page.

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

Practical EMS

02/23/25 • 26 min

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

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Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
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Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

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

Practical EMS

10/20/24 • 32 min

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

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

Practical EMS

12/22/24 • 33 min

New panel! Lucas (ER physician), Kendra (Charge RN, NP student), Ben (paramedic and educator)

Kendra talks about her advice for new charge RN’s

Have some ER experience first. She says it was difficult starting as a charge when she was so new to ER. Have a good set foundation.

You need to be able to have difficult conversations with people in a tactful way to address problems

Getting to know the providers on a more personal level also allows you to better counteract interpersonal conflicts

Lucas talks about how a good charge nurse is a problem solver. He doesn’t view himself as the captain of the ship as an ER physician. He views the charge nurse as the problem solver and it’s their job to make sure every patient is managed in the department

The progression from EMT to paramedic is a similar advancement as RN to charge RN. Thinking outside the box instead of just task-oriented work

Paramedics must learn to allocate resources appropriately rather than do the tasks themselves

Simulation based training has help new paramedics learn to lead calls and see the time it takes for tasks to get completed

Paramedics do tend to have chips on their shoulders, a lot of this has to do with the difficulty of the job and how it is fairly new by comparison and the history of EMS is often us trying to prove ourselves

Lucas discusses efficiency tips in the ED

Chart with the same basic structure regardless of the chief complaint

The physical exam can be very basic and general with a very detailed focused physical exam based on the complaint

Sometimes documenting a physical exam that is too thorough can bite you later when you have to answer why you did a cranial nerve exam on an abdominal pain patient

Document what was done and do what you document

More is not always better

Document twice as much as you think you need to on the relevant components

When you are new as a physician or APP you should be ordering more and documenting more

Try to batch tasks. When you get up go see multiple patients rather than one at a time

It’s better to do the right tests rather than use a shot gun approach every time

You should be able to answer what you are looking for with a given test

On most patients, you should be able to form a plan after getting the HPI and physical exam

We should seek to avoid stacking orders, sometimes it’s inevitable when unexpected results pop up

Stacking orders reall

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My Journey to the Boulder Half Ironman

Practical EMS

06/17/23 • 10 min

I have no experience with triathlons. I would have never considered myself athletic. I've run one race longer a 5k my entire life. I decided that a half ironman would be a very ambitious race to train for and complete.

I'm a big believer in trying hard things that put you outside of your comfort zone to help improve yourself as a human. You don't even need to know everything about a difficult task before you start. Colin O'Brady talks in his book, The 12 Hour Walk, about life's 1's and 10's. In his many physical accomplishments, like hiking across Antarctica, he has had a lot of 1's: almost dying, being so physically exhausted that he thought this task was going to prove impossible. But he claims that these "1's" are there so you can experience the 10's in life: finishing a task so big that no other human can claim to have finished.

This is what the half ironman represented for me. An ambitious task that sounded almost impossible. It required me keeping a lot of commitments to myself. It required me to start training without all the head knowledge already in place and learn along the way. There were a lot of 1's in this journey but it was totally worth it for the 10 of crossing that finish line and seeing my wife and two girls waiting for me. Whatever your ambition I want to encourage you to get started. You don't have to know all the ends and outs. You don't have to even feel confident you can finish. Just start. Take little steps each day and the finish line with be there before you know it.

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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.

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Caring for a gunshot victim when trying to get coffee

Practical EMS

07/14/24 • 32 min

We meet our new panel:

Eric (EM Physician)

Shelby (EMT)

Nate (EMT) and returning guest

Sam (Prior EMT, ER RN)

DeTessa (ER RN)

Part of the fun part of the ER is getting to start from scratch and figure out the puzzle

Stories do change as the patient talks with different providers

We are not equipped to diagnosis or resolve chronic problems in the ED, we can’t provide every answer for every symptom

The mindset of the public of what the ER is vs reality is often quite different

We do need to understand that waiting for your ER work up can be very difficult as a patient, especially when you are in pain.

We need to have grace for this patient perspective

We talk about GSW patients and chaos that is present on scene and in the hospital
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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.

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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

Practical EMS

10/13/24 • 29 min

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

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Take care of yourself BEFORE you take care of patients.

Practical EMS

02/25/24 • 35 min

We meet our new panel and some returning guests!

Kiley – ER RN and new NP

Sarah – Paramedic in EMS for 8 years

Welcome back Adam ( ER MD), Casey (paramedic) and Nate (EMT).

Nate talks about the transition from field EMT to ER EMT. It’s a new world with new things to learn.

Sometimes a change in environment can get you out of a rut.

Sarah also worked in the ER but as a paramedic and loved learning new aspects of medicine but her scope was diminished compared to the field.

Paramedics are still a new asset in the ED and have a fluid job description.

Principles in emergency medicine

1. We do not diagnose in the ER.

2. Take care of yourself before you take care of patients.

Sarah recommends outlets and hobbies that are totally separate from medicine.

Make yourself a priority or you will end up neglecting yourself.

Sleep deprivation will affect you more than you think.

Casey talks about how you can get lolled into relaxing by low acuity calls but then you may be tested to your limits the very next call.

Kiley talks about patient autonomy and how it is our job to present options and educate but the patient must ultimately decide to accept or reject our options whether we agree with it or not.
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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

Practical EMS

01/26/25 • 22 min

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

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

Practical EMS

09/22/24 • 26 min

Matt talks about our reliance on technology and how sometimes it is nice to remember that to assess a patient it is actually really simple without using technology

Andrew: I am mostly paid to not get tricked into missing something big.

Standards in medical education changing when there is emphasis on getting people through programs

Keep holding high standards for your students

Advice for the newbies:

Andrew: You won’t fail if you are trying your best and making the best decisions you can and caring for the patient

Aaron: Take care of yourself before you take care of patients

Matt: Ask for help if you need it.

Julie: Be content with where you are at

Sarah: Progress further in medicine if you can do it

Schasny: Don’t listen to the naysayers. Zero to hero is possible because everyone is different

You can learn from all providers, even if they haven’t been in the field long. Sometimes experience can be greatly varied even with only a short amount of time in the career

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

Practical EMS

04/20/25 • 36 min

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

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FAQ

How many episodes does Practical EMS have?

Practical EMS currently has 105 episodes available.

What topics does Practical EMS cover?

The podcast is about Health & Fitness, Physician Assistant, Ems, Medicine, Paramedic, Podcasts, Education, App and Emergency Medicine.

What is the most popular episode on Practical EMS?

The episode title 'Are paramedics well equipped to go to PA school?' is the most popular.

What is the average episode length on Practical EMS?

The average episode length on Practical EMS is 29 minutes.

How often are episodes of Practical EMS released?

Episodes of Practical EMS are typically released every 7 days.

When was the first episode of Practical EMS?

The first episode of Practical EMS was released on Dec 21, 2022.

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Practical EMS

Practical EMS

Top 10 Practical EMS Episodes

FAQ

How many episodes does Practical EMS have?

What topics does Practical EMS cover?

What is the most popular episode on Practical EMS?

What is the average episode length on Practical EMS?

How often are episodes of Practical EMS released?

When was the first episode of Practical EMS?

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