Struggles in emergency medicine Casey struggles with keeping up with the changes, especially the technological changes.  If you worry about keeping up, put yourself in a position to teach the new people. They will force you to learn as well. Micaela talks about her personal struggle with burnout and the significantly high acuity calls she has run She ran a ton of high acuity in a short amount of time. She had difficult partners and students. She was a critical part of a shooting that made...

We welcome our new panelists.  Micaela (paramedic) Simone (former ER RN and now ER NP) Paramedic’s Alex and Casey returning.  Simone gives us a glimpse into the tough transition from ER RN to ER NP.   You need to love the medicine.  Having to know so much of so many things was one of the toughest parts.    You must be second best at every specialty.  Alex talks about the transition from EMT to paramedic.    Being in a system that creates strong EMT’s makes the process easier.    Being able to...

Emergent Standards I address a comment about how we mentally handle the patients we care for that have committed violent crimes. We still care for them to the best of our ability; in fact we often learn the whole story after we have finished caring for them. We don’t judge because that is not our role. We find ways to move on from the horrible situation. Emergency standard: Take care of yourself before you take care of patients.  75 Hard has completely changed my mindset. I actually stick...

Confidence in EMS: Nate talks about how he was reaffirmed when learning ALS meds and a physician agreed with his treatment plan.  School does not make you confident. As a provider, give the crews feedback because it helps them grow and confirm their plans and treatments were accurate. Don’t just give negative feedback. Some students do need an extra push to make them uncomfortable enough to progress or realize how far they still must go. They need to develop critical thinking for when they...

Random stories episode! We often don’t want to talk about the “craziest” call we’ve ever seen. I tell a story about a fireplace fueled by batteries and no real medical reason for the call.  We talk about things that surprised you about emergency medicine Dealing with drunk people is a challenge. Other great random stories: Thoric dissection’s, triple A’s, rhythm changes, driving lights and sirens, hitting deer, getting into accidents. If you want to work on your nutrition, increase your...

Jumping back into our discussion on alcohol abuse in EMS. Everyone is susceptible to overuse of alcohol so abstaining can be powerful even without it being your vice.  Interpersonal communication skills are key to developing in EMS. We need to connect with our patients. Patients care more about being understood and listened to than good medicine. Advise for newbies: It’s hard to admit when you have a problem but that is the first step to fixing it. It’s okay to fail but you need to pick...

New panel! We welcome Alex, paramedic and Kate, EMT. Welcoming back Sarah, paramedic and Nate, EMT.   What makes a great paramedic? Treat your EMT’s like a partner. Talk about calls. Teach your EMT’s. Educate without belittling.  Create an environment where your partners can question the plan if they don’t understand it. Learn from those that have been doing this for awhile. What makes a great EMT? Ask questions. Have desire to improve. Nate talks about his struggle with alcohol When you...

You guys ever see a dead family member in a patient? Like they look similar, act similarly? No? Maybe it’s just me. Nate talks about his life experiences and how it helps him talk with patients that are struggling with mental health. He talks about a patient experience where he really connected with a patient and how the patient was seen years later having changed his life.  We talk about God in EMS and the really unfair and tragic things we see. How this will test your faith.  Kiley talks...

Leadership in emergency medicine Good nurse to patient ratios is very important to good patient care and allowing those little moments where you can spend some extra time making sure the patient feels cared for.  Management doesn’t always equal good leadership.  Part of being a good leader is being the calming presence in a chaotic scene or situation. Walk, don’t run. Be mindful. You can be freaking out internally but externally you must show confidence and calmness.  Sarah tells a story...

Is burnout moral injury? Is it out of your control? ZDoggMD talks about burnout being moral injury.  Link here: (30) It's Not Burnout, It's Moral Injury | Dr. Zubin Damania on Physician "Burnout" - YouTube We jump back into our discussion on the video. Casey says one of the great things about this job is that we have the privilege to be with people on their worst day. Nate talks about the conflict we sometimes have one scene when treatment plans are not agreed upon. He talks about burnout...

Jumping back into Principles in Emergency Medicine Nate- People lie. Despite the fact that we are not judging them, and just need to know accurate details to provide the best possible care.  Casey- Expect the unexpected.  EMS is long periods of boredom punctuated by moments of sheer terror.  Adam- the job is always out to get you. We see the 1%, it is a self-selected population. So, if you are going to consider a rare or uncommon diagnosis, you are more likely to find it in these patients. He...

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...

We revisit the question “Where is God is emergency medicine? Doug- I’m a believer in science and a believer in God.  There are some occurrences that we can’t explain with modern medicine. He tells the story of a cardiac arrest that woke back up an hour after pronouncement.  Sarah- God has given us the science to learn and be able to use.  We often see the victim of a horrible tragedy as well as the person that caused the trauma. It’s hard to believe there is a God when we see such injustice...

Crazy stories episode Delivering babies!  Not something most of us look forward to but it happens, nonetheless. Casey talks about a breech presentation birth that, thankfully, turned out just fine despite delivering at 28 weeks in an ambulance as well as a prolapsed cord case. Stabbing victims! In a sex shop, in their homes, we run them everywhere. Butt stories! Stuck vibrators with full batteries, flashlights you name it.  Shitting in a trash can. This episode has it all. Everything you hear...

Pronouncing in the field is a difficult part of EMS. In a lot of ways, the ED insulates us from some of the aspects of this that make it challenging when you are in the patients actual home.   The ED is mentally taxing in other ways. High volume, high acuity, multitasking, consulting etc. Nate talks about how “you’re just an EMT” gets thrown around a lot. Just because it’s a lower-level of education doesn’t mean that EMT’s don’t have valuable information and knowledge level.  Collaborate with...

Challenges in emergency medicine Burnout can creep up on you and can occur even in one shift. Nate got burned out working nights and started drinking heavily and almost got into blows with his partner. He went through a tough period and came out the other side. Substances will become an easy outlet and a way to avoid dealing with real problems if you allow them. Everyone has their coping strategies; you need healthy ones. Casey- If you run 2000 calls a year or more you may burnout, if you...

Jumping back into failures in emergency medicine Doug, ER physician, discusses how he missed a traumatic intraabdominal injury and an ectopic pregnancy. It’s easier in hindsight to see the things we could have done better. Admitting you screwed up can be difficult.  Leave work at work as much as possible Nate talks about a patient that was initially written off as flu like symptoms, with no initial vitals being obtained that end up being in V-tach.  Anchoring bias is a big problem. Overcome...

January Panel Episode 1 We’ve got some awesome experience here today. Physician, Nurse, PA, paramedic and EMT! We introduce Sarah, 9 year nurse with 4 years of experience in the ER. She is inspired by the team mentality in the ED as well as the unique situations. Inspired by her grandmother who was a nurse when emergency medicine was a developing specialty. We welcome back Casey. Long time, experienced paramedic, practicing here for 30 years.  Nate is back. EMT for 9 years. Comes from a heavy...

I discuss the position of an ER PA and how it relates to the physician role. I strongly believe in practicing as a team with physicians, I see this as integral to the PA career. We talk about autonomy as a EMT/paramedic or PA. EMT’s and paramedic are a perfect career to step into the role of a PA because of their autonomy.  Teaching is a key part of medicine and especially important for physicians to teach others.  Adam explains what he would want people to know about being an ER physician....

Welcome Dr. Les to the show. Finished his EM residency in 1999, 24 years spend as an attending, estimates 130K patient seen in that time. He tells us about a busy night shift in the ED where he had to take care of an easy laceration but how the busyness of the night made him overlook something simple. I follow this up with a story that makes me look like an idiot but sometimes it’s okay to laugh at yourself.  Les would tell his younger self that all the work he has done is worth it but some...

We welcome a new panelist. Flight paramedic Ashaley. She has been in emergency medicine for 11 years. Ashaley tells us about an impactful story from a patient that told her “Make sure you take moments. Life will always get out of control but, stop and go look at the sunset because sometimes you have things you can’t get back.” Kierra talks about some stories she has from when she was newer nurse and was overwhelmed vs the ability and confidence that comes with experience. She shocked a...

Warning: This episode starts pretty heavy We talk about an absolutely horrific and tragic call that Nathan ran and how he has healed from something no one should ever have to see.  Casey tells us about how patient's can impact us even in non-emergent settings. Casey and his partner help a patient attend his son's wedding and spark the inspiration for a nationwide program to help patient's that are bedbound attend special occasions for free. Kierra tells us about the importance of taking your...

Real Stories in Emergency Medicine Part 1 Meeting our December panelists and diving into some real stories Nathan - EMT of 9 years Casey - Paramedic of 47 years Kierra - ER RN for 7 years Aaron (host) 15 years in EM as EMT, paramedic and ER PA Adam -  ER Physician with 21 years in EM Do you work in emergency medicine? An absolutely crazy and intense environment where you see things every day that a regular person doesn’t see once in their entire life? Do you feel burned out,...

Full episode finally coming next Sunday! Last teaser episode until the full episodes release starting next Sunday December 10th! I introduce one of our final topics of discussion in the December panel series.  Where is God in emergency medicine?  This has been a question I have personally wrestled with over years of witnessing tragedy, horrific accidents and even some triumphs. I think it's easy when everything goes well. It's much more difficult to answer when things go wrong.  I hope...