Chris and I talk about my background and motivation for my podcast. I talk about a pediatric arrest I ran that had a huge impact on me. We tend to dehumanize patients in this job to keep our distance, but that is not always the best technique.Emergency standards are standards I have developed working in the ER.One of those standards is to walk slowly through the department. Become mindful. Be intentional and in the moment. Think through the proper order to complete your tasks. It is not your emergency.Mindfulness practices are key to mitigating anxiety and stress. Getting off work on time is key to separating work and life and maintaining that balance. Of course, much of this is outside your control, but control as much as you can. Let the shift go before you get home. Refocus on the rest of your life.Take care of yourself before you take care of patients. Self-care is critical.Overtime is often needed when you need to focus on making money, but this cannot be sustained long term.Daily, consistent discipline will prevent a crisis or emergency down the road.Debriefing and talking through cases can help you process and heal from them.Acute and chronic burnout are different problems and require different solutions. Focus on the factors you have control over. Know your why. A powerful why can overcome a lot of how’s.Check out Mind the Frontline below and help their mission to improve lives of first responders:Resilient Response: Self-Care Strategies for Emergency Medicine (mindthefrontline.org)Support the Mission (mindthefrontline.org)Support the Show.

Wrapping up our conversation with Brian and Kristina (PA’s and prior paramedics) and Casey (paramedic)Shadow PAs in different specialties so you really know what the career looks like practically. Use this to find out what specialties you like, school doesn’t always give you enough time and you may not get a job in your desired specialty every time.You must know WHY you want to be a PA. Have a very clear understanding.Don’t be completely set on working in the ER as a new PA. There are a lot of other valuable specialties to gain experience in before going to the ER.Paramedics are well equipped with knowledge and experience for PA school. There is a lot more to learn but, in many ways, paramedics are one of the best careers to transition to PA from.Most of medicine does not understand the high level of training that paramedics receive.If you are an EMT planning on PA school, learn from your paramedics. In EMS, learn from those with experience regardless of their provider level. If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks:https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMSMy favorite creatine supplementhttps://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf 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 NutritionEverything 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.Support the Show.

We jump back into our conversation with Brian, Kristina and Casey Advice for newbies Reflect on the calls that you run. What went well and what went poorly? Are there providers that did a great job that are worth emulating? Find those mentors that are worth emulating. Also make note of those that are worth avoiding.Keep in mind there are multiple right ways to do things. All of us in emergency medicine need to be ready to teach. Students and patients.The ability to teach demonstrates true understanding. Teach your thought process. Going from EMS to PA. It is not a quick process, and it is very expensive.It is hard on your family. You need a support system. You may be lonely. Paramedics, in a lot of ways, are well prepared to go to PA school but their skill set is not equipped to manage diseases long term. A lot of what most PA’s do is specialty work on disease processes long term and not emergent conditions.  Being an ER PA is a lot different than it may appear from the outside. A lot of our job is care provided away from the patient. We tend to be the limiting factor, so we have to use our time efficiently. We are isolated from tasks that allow you to do the work reflexively. If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks:https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMSMy favorite creatine supplementhttps://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf 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 NutritionEverything 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.Support the Show.

We meet our new panelistsBrian and Kristina (PA’s and former paramedic’s). Casey is back! Transitioning from paramedic to PA Professionalism is a big emphasis in PA school. This was something I learned as an EMT from a great paramedic partner early in my career as well. Professionalism in EMS is a cultural and personal aspect to strive for. PA school also wants you to keep in mind you are representing their program and PA’s in general. Teaching the newbies We all need to have the confidence to pull aside the newbies and make them aware of dangerous overconfidence and arrogance when we see it. Even though it is confrontational. Seek out mentors when you are new.Be a mentor for new people because sometimes they aren’t confident enough to ask for one. We don’t really have to find the exact problem that the patient is having, we are trying to figure out what the patient needs. Be an investigator. If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks:https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMSMy favorite creatine supplementhttps://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf 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 NutritionEverything 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.Support the Show.

We discuss what things we want others to know about our careers.In EMS we can tend to jump immediately to being confrontational, even when the other person isn’t meaning to be confrontational.We all have different scopes and different levels of knowledge.Casey wants people to know that paramedic’s get extensive training in 12 lead interpretation.Lucas wants people to know that doctors are not the boss or supervisor or the manager, we are a team and we each have our roles.Egos tend to make people see the system in a hierarchy. We all need to be willing to teach and check our ego.A good EMT will catch things that paramedics are missing. Nurses are hard workers and tend to be on their feet longer than paramedics.Advice for newbies:You can’t save everyone, regardless of how well you function.The job is not all emergencies. Take care of yourself before you take care of others. There may be times when you must prioritize other things in life, but long term, you must take care of yourself.Have an identity outside of your profession.Create rituals that help you perform during your day.Casey prays every day before his shift to be his best self and take the best care of his patients.Keep a journal. You may want the specifics of certain details later in life.Create healthy hobbies.If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks:https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMSMy favorite creatine supplementhttps://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf 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 NutritionEverything 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.Support the Show.

Meaningful patient interactions – Hold on to them.The mundane calls, the rude patients, the horrible things we see -  those are the price we pay for the one call where you save someone or have a meaningful interaction.It is an honor to take care of patients that can’t get help in any other medical setting except the ER. Find one thing every shift that you find fulfilling. Be intentional. Find that thing. Someone sweet, someone grateful, someone you helped.You need the right expectations. Not every patient is dying, and too much high acuity will actually take its toll on you as well.Micaela talks about the MCI she ran and her question of how could God be present in the destruction. She came to realize that God is not in the event, He’s in the healing and the processing of the event.Providers should be educating those with less education and that want to learn.Some things get easier with time, and you don’t have to think about them as much. If you want to support the show, follow the links below for some great health and fitness products.My favorite protein:https://1stphorm.com/products/phormula-1/?a_aid=PracticalEMS My favorite 1ST Phorm Energy Drinks:https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMSMy favorite creatine supplementhttps://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf 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 NutritionEverything 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. Support the Show.

Our new panelists:Lucas- ER Physician, Micaela- Paramedic, Alex- Paramedic, Rebecca- ER RN, Casey- ParamedicWe discuss struggles with caring for patients that have perpetrated violent crimes.Recognize your own bias and your personal history that may affect patient care. It’s important to have a good self-care plan because you can’t pour from an empty cup.Pediatric calls will stick with you. They require intentionality to overcome.We all carry scars with us.Understand that we are human, and it is normal to feel emotions, but we owe it to our next patient to continue to be our best self.Don’t miss opportunities to tell your family and friends you love them. Life is fragile.Find the “thing” that works for you to help you heal from the things we see. Exercise, walk, talk with someone, watch a movie.Overcome the challenges in a healthy way. Healing instead of coping.Embrace the beautiful moments.If you want to support the show, follow the links below for some great health and fitness products.My favorite 1ST Phorm Energy Drinks:https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMSMy favorite creatine supplementhttps://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf 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 NutritionEverything 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.Support the Show.

Struggles in emergency medicineCasey 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 runShe 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 national news. She was medical control on a significant MCI as well.Some paramedics will have periods of time that are much higher acuity than normal.Some EMS systems are so busy that you gain experience much faster than others.Casey talks about a pediatric cardiac arrest that we were able to get back and had a good outcome. Making that human connection is important to preventing burnout. But it needs to be done with some wisdom. We cannot pick up burdens all day that our not ours to bear.Physical touch has power. We all want to connect with patients, but this is difficult in certain settings. You must balance this with the emergent patients that require more of your time.Burnout is avoided by connecting with patients.If you get to know them, they might surprise you with their amazing stories.If you want to support the show, follow the links below for some great health and fitness products.My favorite 1ST Phorm Energy Drinks:https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMSMy favorite creatine supplementhttps://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf 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 NutritionEverything 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. Support the Show.

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 think back to times when you were an EMT and what your paramedic did in certain scenarios is a great frame of reference.   Transitions like this are difficult to explain until you have lived them. Not having that safety net is a big difference. Confidence only comes after practice in the field, not in school.Don’t make the mistake of thinking you know everything. It can be a dangerous mentality. Critical procedures should always be taken with the seriousness they deserve. Casey talks about pericardiocentesis (please follow your protocols)Cricothyrotomy storiesCasey takes about doing this in the back of a helicopter. Think about having to cric every time you intubate a difficult airway.RSI discussion  My favorite creatine supplementhttps://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplement https://1stphorm.com/products/project-1/?a_aid=PracticalEMSIf 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 NutritionEverything 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.Support the Show.

Emergent StandardsI 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 consistently to goals that I set for myself like never before. I can get up early before work and get myself in the right mental space to take care of patients to the best of my ability.Practical tips:Pack your food. Pack your water.Track calories and macros.Wake up early.Daily exercise.Leave for work early.Wake up before your family.  My favorite creatine supplementhttps://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS My favorite pre-workout supplementhttps://1stphorm.com/products/project-1/?a_aid=PracticalEMS 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 NutritionEverything 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.Support the Show.

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 have no safety net. Running calls when you don’t agree with the other responders/providers:Be blunt when you believe a treatment can be negligent. You must advocate for your patient even when this means confrontation.Certain treatments have the potential to harm. Aggressive treatment is not always needed.State where you stand when you disagree. It can be difficult to broaden the differential when another provider is totally fixated on the initial impression.We need to approach as a team. Have discussions. Be willing to consider your rationale for why you believe what is the right treatment path.                                                                                    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 NutritionEverything 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. Support the Show.

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 medicineDealing 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 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 NutritionEverything 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. Support the Show.

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 yourself quickly back up.Know you are not alone with these vices, be it alcohol or something else.You must be prepared for that next difficult call or life event. Because it is always coming.It is helpful to have friends that do EM and friends that don’t do EM so you aren’t always centered around work.Our dark humor in EM is needed to help put things on the back burner so we can move on in the moment, run that next call or see that next patient and deal with it later.Sarah tells a story about a grandma that passed away then immediately running a baby being born. Nate tells a story about connecting with a patient and that how that is the exact reason he got into medicine.Kate talks about how it’s worth taking the time to explain things to patients. 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 NutritionEverything 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. Support the Show.

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 alcoholWhen you crave alcohol or vice in general, you usually have one of the following:HALT: hunger, anger/anxiety, loneliness, tiredness.  Alcohol abuse is a huge problem in EMS.It being so socially acceptable makes it more difficult to overcome. Alex and Nate open up about how they have had success overcoming this vice. EMT schools sound like they are doing a better job at preparing EMT’s in the skills needed to verbally deescalate a situation and empathize with patients. 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 NutritionEverything 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.Support the Show.

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 about how, seeing so much death, it’s seeing the patients themselves in their last moments that convincing her there is a God.BurnoutLean into your coworkers, share your feelings. Talk with people to help heal.Follow up on that critical patient you are worried about. Avoid substances.Talk with people about how you feel.Use those frustrations to exercise or do something productive.Calls add up over time. Sometimes it not just one call, its multiple in a rowIf 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 NutritionEverything 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. Support the Show.

Leadership in emergency medicineGood 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 about going the extra mile to simply get a patient a coke. Sometimes these small things that we overlook make a huge difference to the patient and pay huge dividends to you personally. It doesn’t take hardly any effort to go above and beyond.Casey talks about a patient that he went the extra mile for and how it completely changed the patients’ affect from mean and grumpy to much happier and gracious with the staff. He remembers that case from 30 years ago because it made such a difference to him and made the job worthwhile.This job is about service for others. If you don’t want to serve, you are in the wrong job.A big risk with going zero to hero is you may have done a lot of work to find you don’t like the career. You must be willing to teach and be taught in this field.Burnout can really be decreased when we take short moments to make a patient feel cared for and listened to.We need to make patients feel heard and treat them like human beings.Casey tells another cool story about a stroke patient with resolved symptoms after he was able to deliver fast treatment.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 NutritionEverything 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. Support the Show.

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" - YouTubeWe 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 from not trying to get to the source of a patient’s psychiatric problem and just medicating them. Kiley talks about the reality of practice vs school and that we can’t fix every problem we encounter. We can take the time to be empathetic and this can help combat burnout if you allow it.The sorrowful aspect of our job is really difficult. You must know your limitations. Kiley discusses how sometimes we can’t do much to help or even do adequate alleviation of pain, and all we can do is hold the patients hand. We all got into this job to serve others and we can lose sight of that. We need to remember to express appreciation for each other in the quick moments we have before chaos descends again.Leadership is key at every level in emergency medicine. Saying no to a bad plan takes some confidence and leadership skills.A good leader takes weight off other people’s shoulders by leading well. By doing everything we can for a patient.A good leader can take criticism and remains humble. They take the opinions of others into account.When something goes well, give away the credit. When something goes wrong, take responsibility.Good leaders know when to follow. They are not dictators. When everyone leads at their own level, chaotic cases come together smoothly.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 NutritionEverything 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.Support the Show.

Jumping back into Principles in Emergency MedicineNate- 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 found a passive pulmonary embolism in a patient with very mild and vague symptoms.Casey- Arrogance can really cloud your judgment. You must be more confident in what you don’t know than what you do know.Nate- pay attention to those subtle details like bradycardia. It could indicate a bigger problem than initially thought. Watch your ego because it may cause you to focus too much on a differential and ignore details to the contrary. Casey tells a story about a woman who was assumed to be drunk but just had a low blood sugar.Adam- Know the difference between confident and cocky. Kiley- A confident provider with a clear plan is very helpful to nursing staff because they can convey this to the patient, and everyone is on the same page. I always plan on a negative work up because a positive work up will dictate the plan.Sarah- Don’t stop learning. Look things up. Learn every day.ZDoggMD talks about burnout being moral injury.  Link here:(30) It's Not Burnout, It's Moral Injury | Dr. Zubin Damania on Physician "Burnout" - YouTubeI agree with certain aspects of what he is discussing but I also believe there will always be aspects of our job we cannot control so we must remain focused on the things we do have control over. Ourselves. Our patient care. How we show up. Adam- The emergency department is unique in medicine because we don’t have a lot of oversight and rules from the insurance companies. We can order the tests and take care of the patients regardless of their race, gender, insurance coverage. We are the safety net of society.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm products. Check them out here so they know I sent you.1st Phorm | The Foundation of High Performance Nutrition 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.Support the Show.

We meet our new panel and some returning guests!Kiley – ER RN and new NPSarah – Paramedic in EMS for 8 yearsWelcome 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 medicine1.      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.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm products. Check them out here so they know I sent you.1st Phorm | The Foundation of High Performance Nutrition 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.Support the Show.

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 in the world.I talk about the difficulty taking care of a drunk driver who was the reason for the death of his friend in the passenger seat. Casey prays every day before work for the safety of his partners and that he would be the best paramedic he can be.Casey tells an awesome story of recovery from a horrible head injury. How it redeemed this person from a bad path in life. Advise for those struggling:EMS changes every day. So, stick around and don’t give up. Avoid substance abuse. Don’t neglect your emotions.Hold on to the good calls.Find something you’re passionate about outside of emergency medicine. Use it to get the frustration and the things that bother you out.Take a break. Talk to someone.If you are a nurse. Know that you have to be true to yourself and you can always switch nursing specialties if you need to.Write down the victories.You must be intentional with your mental health.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. Support the Show.