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

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/

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