Critical Levels

Shift work is a core part of paramedicine, but growing evidence shows it carries real long-term health risks. In this episode, with Dr. James Gilbertson, we explore the science behind circadian rhythm disruption, the impacts of sleep deprivation, and how lifestyle and longevity medicine can help mitigate risk. Key Topics Covered: Why shift work affects lifespan and health outcomes Circadian rhythm...

In this episode of Critical Levels , Zach sits down with Dr. Anna-Maria Carvalho , a Royal College–certified emergency physician with a subspecialty in aviation medicine, to unpack what really happens when someone asks, "Is there a medical professional on board?" From the physiology of flying at 36,000 feet to the realities of managing cardiac arrest in a cramped aircraft cabin, this episode tackl...

On this unique episode, we attend the First60 Toronto Resuscitation Conference and interview several of the speakers. For more detailed information, check out our website, criticallevels.ca

In this episode, Zach sits down with Dr. Ian Drennan and Dr. Sheldon Cheskes to dissect the newly released 2025 AHA and ILCOR resuscitation guidelines . They break down the evidence, controversies, and real-world implications for paramedic practice. Key Topics Covered 🔹 How guidelines are actually created 🔹 Mechanical CPR 🔹 Heads-Up CPR 🔹 IV vs IO Access 🔹 Medications 🔹 Defibrillation Scienc...

In this episode, we explore the science, history, and frontline application of End-Tidal CO₂ (ETCO₂) — a tool that offers real-time insight into ventilation, perfusion, and metabolism. Danny and Rance from DnR explain how paramedics can use ETCO₂ to assess and guide care across multiple patient presentations. Key Takeaways: ETCO₂ is the sixth vital sign — reflecting ventilation, perfusion, and met...

Delta Air Crash: Paramedics on the Frontline of a Mass Casualty Incident In this gripping episode of Critical Levels, host Zach Cantor sits down with Ornge Critical Care paramedics Colin and Darren to discuss their response to the February 2025 Delta crash at Toronto's Pearson International Airport. From the initial plume of smoke spotted mid-flight to interagency coordination on the ground, they...

What is a paramedic — really? In this thought-provoking episode of Critical Levels , Zach sits down with Dr. Alan Batt to unpack the evolving identity, responsibilities, and future of the paramedic profession. Together, they explore the disconnect between what paramedics are trained for versus what they actually do, the consequences of outdated education models, and the urgent need for professiona...

Neonates are one of the most feared patient populations in EMS—and for good reason. In this episode, Zach Cantor talks with Anthony Iacolucci , a pediatric respiratory therapist and paramedic, about how to confidently approach neonatal calls. Anthony introduces   NEO SECRETS , a practical acronym covering the top 10 causes of neonatal illness, and offers insight into assessment, common pitfalls, a...

In this episode of Critical Levels, we dive into the cutting-edge strategies shaping pre-hospital and emergency department care. Our guests discuss how data-driven decision-making, high-performance CPR, and improved handover processes are revolutionizing patient outcomes. Key Topics Covered: ✅ High-Performance CPR: The role of real-time feedback, mechanical CPR devices, and quality metrics in imp...

🔹 Key Topics: 🔸 Why medics need to understand K9 trauma care The overlap between human and canine emergency medicine Common injuries in police, military, and search-and-rescue dogs 🔸 MARCH for Canines—What's Different? The first "M" stands for Muzzle —securing the dog's "weapon" before treatment Understanding the similarities in trauma care between humans and dogs Key differences in how canines...

In this episode of Critical Levels, we tackle frostbite with Dr. Maria Doubova, exploring its pathophysiology, symptoms, and treatment. From outdoor enthusiasts to vulnerable populations, frostbite affects diverse groups. Learn about early early recognition and management of frostbite - from mild frostnip to severe cases requiring advanced interventions - and the latest classification system to im...

Welcome to the first episode of 2025! This month, we're diving into the critical role of Tranexamic Acid (TXA) in pre-hospital trauma care. Dr. Erik Vu, a critical care flight paramedic, emergency physician, and intensivist, joins us to discuss the latest insights and applications of TXA, particularly in dynamic and tactical environments. From its role in stabilizing clots to its use in mass casua...

On this month's episode, we are going to talk about prehospital blood administration with Dr. Peter Antevy Some topics covered are: Historical trauma management  Blood why  blood components  administration ratios  blood type  Blood administration who do we give blood to medical vs trauma (blunt vs penetrating)  elderly vs peds  vital sign parameters when do we administer it  how do we give it IO v...

How prepared do you feel to care for children and youth who have experienced abuse or assault? 1 in 10 Canadians (7.8%) over 15 report at least one instance of sexual abuse before age 15 ( Stats Canada ) Up to 88% of people being trafficked access health care ( Polaris Project ) - many don't disclose they are being trafficked Highest rates of intimate partner violence occur between age 12-24 ( Sta...

On this month's episode, we dive deep into the world of military medicine with special forces paramedics, pulling back the veil of secrecy surrounding their vital work. Join us as we explore the unique challenges and high-stakes scenarios these elite medics faced on the front lines. From advanced trauma care in combat zones to the mental resilience required for their demanding roles, our guests sh...

On this month's episode, we're joined by Dr. Justin Mausz to discuss violence against paramedics.  During the episode, you'll hear us cover: How often are we seeing violence against paramedics What is violence? Is it different from harassment? Does intent matter?  Incident reporting How does it compare to other industries? What does violence against paramedics look like? How do we balance paramedi...

On this month's episode, we're joined by Dr. Steven Sanders to discuss heat related illnesses.   During the episode, you'll hear us cover: Health impacts of temperature increase   Physics/physiology of temperature vs heat Spectrum of heat related illness heat rash heat cramps heat edema heat syncope heat exhaustion   heat stroke exertional vs classic Comorbidities/confounders/risk factors Temperat...

On this month's episode, we're joined by Dr. Bonnie Snyder to discuss BVM as well her recently published paper in Resuscitation: Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest.    During the episode, you'll hear us cover:   There is nothing basic about the BVM - it is not a benign intervention Rate and volume based on the guidel...

On this month's episode, we're joined by Dr. Katie Lin to discuss TBI and the crashing brain.    During the episode, you'll hear us cover:   head injury differentials and history gathering  ischemic vs hemorrhagic  head injury etiology  head injury pathophysiology  assessment 3 step neuro exam  pupil assessments  signs/symptoms of herniation  ECG changes management  avoid/manage the H bombs (hypox...

On this month's episode, we're joined by Dr. Janice Tijssen to discuss pediatric cardiac arrest. During the episode, you'll hear us cover: The importance of our early interventions What is cardiac arrest incidence/epidemiology etiology  risk factors/past medical history outcomes sociodemographics Differences between adult and pediatric cardiac arrest Simplifying our response Symptomatic bradycardi...

On this month's episode, we're joined by Dr. Louisa Marion-Bellemare to discuss Suboxone (buprenorphine/naloxone) and managing patients who use illicit and controlled drugs. During the episode, you'll hear us cover: history of the drug crisis  lay of the land of the current drug crisis historical treatments opiate pharmacology  healthcare utilization  stigma  suboxone use  patient advocacy

On this month's episode, we chat with Matt Smith about wilderness medicine.  As we shift from a high resource to a low resource setting, there are 3 main concepts to consider: - Ideal to real - High risk to low risk - Stable to unstable These concepts are important as we shift our practice and prepare ourselves.  For this patient context, we need to focus on the things we can't replace, and learn...

On this month's episode, we discuss acute coronary syndrome (ACS) with Dr. Jess McLaren We define ACS, we cover pathophysiology, and some common causes. Importantly we discuss the assessment of this patient population - paying attending to both objective and subjectives signs and symptoms. We spend some time talking about electrocardiograms, and perhaps most importantly, we chat about the manageme...

On this episode, we're joined by Dr. James Gilbertson with the Ottawa Hospital, and Cst. Caroline Gallant with   The Ottawa Police Marine, Dive and Trails (MDT) Unit. We take a dive into drowning and cover: What drowning is The scale of the problem Drowning pathophysiology The medical management of drowning patients Prognostication Lastly, we speak to drowning prevention