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

What do you do when the anatomy you've memorized simply doesn't exist anymore? When a patient's entire face is gone, and your standard airway management tools won't work? This is where training meets reality.

Critical care transport legend Allen Wolfe joins us to dissect a real case, a conscious patient with a self-inflicted shotgun wound—no mandible, no nose, no midface—just open tissue and blood spraying everywhere.

This conversation covers the Lefort facial injury classification, why the cervical collar is often more harmful than helpful in penetrating trauma, delayed sequence intubation techniques, and intubating in atypical positions. Allen also explains cerebral perfusion pressure through the Monroe-Kelley hypothesis, and why hypotension can be devastating in traumatic brain injury.

But beyond the technical skills, this episode is about leadership under pressure, verbalizing your thought process to your team, and having backup plans A through Z before you need them. It's about deliberate practice and mental simulation so you don't freeze when chaos hits.

Want to train like this? We built the Paramedic Confidence Builder course to teach you to manage high-stress situations just like this through deliberate practice. You don't rise to the occasion; you fall to the level of your training. Visit our website to learn more and reach out through the contact page- https://emspodcast.com/

Guest/Cast/Crew information-

Guest- Allen Wolfe, CFRN

Host- Ross Orpet, MD

Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear
• Website- www.emspodcast.com

Discover the difference between resistance (your daily shield built through sleep, nutrition, relationships, and spiritual wellness) and resilience (the anaerobic sprint you can't maintain forever).

Recorded on-site at Fast25, James Boomhower, founder of StayFit4Duty, breaks down why the EMS culture of "pushing through" is fundamentally flawed. Using the metaphor of muscle training, he explains that continuing to stress a system without recovery doesn't build strength—it causes injury. The recovery time from a torn mental health muscle is exponentially longer than if you'd simply rested appropriately.

With over 20 years in New England EMS including training to become a licensed mental health counselor, James brings a perspective that's desperately needed in emergency medicine. He provides the missing manual for sustainable careers in emergency medicine. In this episode he discusses why the 5 pillars of resilience should really be the 5 pillars of resistance. He shares vulnerable stories from his own journey, including the colleague who grabbed him by the collar to stop him from burning out while helping others, and even some relationship strategies to prevent your worst shift from destroying your home life.

Resources

• Learn more about StayFit4Duty and connect with James on instagram at @stay_fit4duty on Instagram
• Get The Relationship Action Plan Document
• Supplemental Blog post for this episode

Guest/Cast/Crew information-

Guest- James Boomhower, LMHC-A, MS, FP-C, NR-P, C- NPT, CCISM

Host- Ross Orpet, Will Berry

Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear
• Website- www.emspodcast.com

Ever cried in the ambulance because you felt completely overwhelmed? Sophie Fuller has—and she's done something powerful with that experience. In this raw discussion, the Life and Sirens podcast host shares her most vulnerable stories about impostor syndrome, burnout, and finding your way as a new paramedic.

Sophie's path to EMS started in the most unexpected way—from a 39-day hospitalization that included being intubated over the holidays to signing up for EMT school from her hospital bed. But becoming a paramedic brought new challenges: crushing self-doubt, constant anxiety before shifts, and the fear that everyone would discover she was a "fraud." Sound familiar? You're not alone. This conversation dives deep into the psychological struggles that plague EMS providers, especially new medics who lose their support structure after paramedic school.

Learn the difference between destructive doubt and healthy doubt, discover cognitive reframing techniques to combat catastrophizing and black-and-white thinking, and understand why bravery means doing things scared. Sophie emphasizes one crucial truth: you cannot fight impostor syndrome alone. So hit play and let’s do this together.

**If you're struggling with confidence as a new paramedic, our Paramedic Confidence Builder Course can help. To learn more, reach out via email at ross@emspodcast.com or through our contact page at emspodcast.com or via DM on IG @emsloudandclear**

Guest/Cast/Crew information-

Guest- Sophie Fuller, EMS, HEMS

Host- Ross Orpet

Catch up with us after the show

Instagram- @emsloudandclear

YouTube- https://www.youtube.com/@EMSLoudandClear

Website- www.emspodcast.com

Death is the Bottom: Why EMS Must Rethink Opioid Use Disorder Treatment

"Nobody told me that the bottom had a basement and the basement had a trap door." This powerful quote from a grieving mother reveals the tragic reality: for patients with opioid use disorder, rock bottom isn't recovery—it's death.

Dr. Jason Hoppe, a medical toxicologist from the University of Colorado, joins us to challenge how EMS providers think about opioid overdoses. The one-year mortality rate after an overdose requiring Narcan? A staggering 6-7%—worse than the one-year mortality after a STEMI. Yet we invest far less in these patients than cardiac emergencies.

This episode covers the evidence-based treatments that actually work (methadone and buprenorphine have incredibly low numbers-needed-to-treat to save a life), how EMS can initiate life-saving treatment in the field, and why "tough love" and waiting for patients to "hit rock bottom" is a dangerous myth. Learn how just an extra 6-minutes on scene could save lives, why patients on buprenorphine need MORE pain medication during trauma, and how breaking the stigma starts with you.

Ready to make a real difference? Discover how EMS providers are uniquely positioned to interrupt the deadly cycle of opioid use disorder.

Want to build unshakeable confidence on scene? We have developed a program to help paramedics go from self-doubt and imposter syndrome to calm competent providers others look to in crisis. If you want to learn more about our Paramedic Confidence Builder course reach out via email at ross@emspodcast.com or through our contact page at emspodcast.com or via DM on IG @emsloudandclear

Guest/Cast/Crew information-

Guest- Jason Hoppe, D.O.

Hosts - Ross Orpet, Will Berry

Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear
• Website- www.emspodcast.com

What do you do when the blood pressure monitor shows a number you don’t like? Most providers hit the button again—but what if it’s real? In this episode, we’re joined by critical care transport specialist James Boomhower from Boston MedFlight, recorded live at the FASTCAN conference in Calgary, to break down modern vasopressor management.

We explore how norepinephrine replaced dopamine as the first-line vasopressor, the evidence behind those changes, and what to do when your patient is on three drips and the pressure still won’t budge. James shares practical, real-world insights from the space between the ED and ICU, where seconds matter and protocols are stress-tested in real time.

Key takeaways include: when to trust your BP reading and act, how to choose and sequence pressors based on evidence and logistics, why norepinephrine reduces arrhythmias and improves outcomes, and when to add adjuncts like steroids, sodium bicarb, or methylene blue. We also explore hidden factors like ventilator settings and underlying causes that can sabotage even the best pharmacology.

Want to build unshakeable confidence on scene? We have developed a program to help paramedics go from self-doubt and imposter syndrome to calm competent providers others look to in crisis. If you want to learn more about our Paramedic Confidence Builder course reach out via email at ross@emspodcast.com or through our contact page at emspodcast.com or via DM on IG @emsloudandclear

Guest/Cast/Crew information-

Guest- James Boomhower, LMHC-A, FP-C

https://www.stayfit4duty.org/

Host- Ross Orpet

Catch up with us after the show

• Instagram- @emsloudandclear
• YouTube- https://www.youtube.com/@EMSLoudandClear

Website- www.emspodcast.com