Ross Orpet, Paramedic turned EMS Physician

Loud & Clear: EMS Guiding Principles - Advanced Continuing Education for Paramedics, EMTs & Prehospital Care Providers

Paramedic training is over, you’re in the front seat now. Whether day 1 or day 1,000 you can’t shake the fear you’re underprepared. You were taught to systematically decide if A... do B. But what if “A” wasn’t in the book? The truth is each emergency call is too unique to teach the right response to every situation. We need to go beyond algorithmic thinking and understand deeper principles, the WHY behind the algorithm. When every decision counts you want to rely on a framework that will guide you when things don’t make sense. Loud & Clear: EMS Guiding Principles is your resource to build that...

Author

Ross Orpet, Paramedic turned EMS Physician

Category

Education

Podcast website

emspodcast.com

Latest episode

Jun 29, 2026

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Episodes

The Skill Is Not The Hard Part 29.06.2026

The hardest part of a bad call is rarely the algorithm. In two different interviews I explore some human traps of running an EMS call. I talk with Danny and Rance from DNR Prehospital Education about a choking arrest, a difficult field intubation, and the trainer-trainee dynamic that made the call more complicated than the procedure itself. Then Bobby breaks down the CAFE pneumonic of heuristic tr...

Treat Mom First: Amniotic Fluid Embolus and Other Peri-partum Emergencies 15.06.2026

A postpartum patient does not need to look dramatic to be in real danger. In this episode from FAST 26, Ross talks with Amy Loucks about pregnancy-related deaths, maternal care deserts, postpartum warning signs, hypertension, cardiomyopathy, infection, and the calls EMS can easily miss. Then Elizabeth Garchar walks through amniotic fluid embolism, now often framed as an anaphylactoid reaction of p...

Pressure Matters: Oxygenation vs. Ventilation in Pre-Oxygenation with Scott Weingart 07.06.2026

Pre-Oxygenation is not just putting oxygen on the patient and hoping the sat buys you enough time. In this episode, Ross talks with Scott Weingart after his FAST26 talk on preventing peri-intubation arrest. They get into why many peri-intubation arrests are predictable and preventable, why shunt physiology requires pressure and not just FiO2, and how EMS clinicians can build a field-ready setup wi...

Your Checklist Is Making You Worse: Why Pilots Use Checklists and Paramedics Don't 31.05.2026

A checklist should reduce cognitive load. So why does yours make things worse? Airline pilot and safety officer Glenn Fisher breaks down how aviation refined checklists over decades of crash data and human factors research — from verification-only flows to abnormal read-and-do procedures to defining the criteria for what should actually earn a spot on the card. Want more? Book a Free Coaching Call...

Pediatric Sepsis with Dr. Peter Antevy 21.05.2026

Pediatric sepsis is easy to miss because the first hour often looks ordinary. Kids compensate, until they don't. In this episode, Will Berry talks with Dr. Peter Antevy about the case that still bothers him and why fluids, vasopressors, antibiotics, and hospital feedback all have to be treated as one resuscitation system. Book a Free Coaching Call with us at emspodcast.com/free-coaching-call Sign...

How to Build Procedural Skills - That Actually Stick 14.05.2026

Most EMS skills training creates an illusion of competence. You drill a procedure, check a box, and move on. But what does the research actually show about competency and retention? Dr. Jason Hine (EM physician, SimKit founder) breaks down the actual science of procedural skill acquisition: S-curves, encoding and consolidation, retrieval practice, and why expensive simulation labs often underperfo...

How to Fail Better in EMS: A Framework for Growth 28.04.2026

Stephanie Suzadail's favorite word is "fail." She'll tell you why and how we should embrace it. In this episode she walks through the difference between failure that builds you and failure that breaks you. Why Sisyphus is a warning, not a role model. Why the best clinicians you'll ever work with have made bigger mistakes than you have. Why high-functioning organizations report mistakes ten times m...

The Call Nobody Trained You For — Jim Schmidt on Domestic Violence Recognition 22.04.2026

Most medics walk onto a domestic violence scene armed with instinct and not much else. Jim Schmidt thought 20 years in the fire service had prepared him for anything — until he had to identify his stepdaughter Gabby Petito's body in 2021. In the months and years after he realized how little EMS is prepared to recognize and treat domestic violence victims. What he's learned since has rewritten what...

Great Mentors Shape Better Clinicians 14.04.2026

Don't Be A Field Training Officer Be A Field Training Mentor. Field training is about more than teaching skills, it shapes culture, standards, and the kind of clinician someone becomes. In this episode, Ross sits down with Ben Tacy onsite at FASTCAN to talk about the origins of field training and why Ben prefers the language of mentorship over “field training officer”. If you care about leadership...

Frozen Fingers, Time Is Tissue: The Prehospital Approach to Frostbite 01.04.2026

Frostbite is more dangerous than it looks and easier to make worse than you think. In this episode, Ross and Will sit down with Dr. Greg Doctor, a wilderness medicine specialist and emergency physician practicing in the Colorado Rockies, to break down frostbite from the prehospital perspective. Greg walks through field assessment, when to rewarm vs. when to leave it alone, pain management, and whe...

Suction First: Dr. DuCanto on the SALAD Technique for the Contaminated Airway and What Comes Next 09.03.2026

The contaminated airway is one of the most unforgiving calls in prehospital medicine. Blood, vomit, debris — your laryngoscope goes in and you're blind. For decades, paramedics managed this with tools designed for a clean OR and training that never got close to the real thing. Dr. Jim DuCanto decided that was unacceptable. He's the anesthesiologist who invented the DuCanto catheter and SALAD (Suct...

Wired to Fail: The Science of Human Error in EMS 25.02.2026

What if the mistake wasn't your fault... but it's still your responsibility? That's the tension Shay Montgomery sits with every time she talks about the day she flew to a scene without the drug bag. Shay is a flight nurse and educator. At FAST 25, she gave one of the sharpest talks of the conference — not on a procedure or a drug, but on the science of why humans make mistakes and what we can actu...

Dump Kits and Checklists: Why Expert Paramedics Still Crash 09.02.2026

Miss your first intubation attempt and your patient's risk of adverse events jumps sevenfold. By the third attempt? Nearly guaranteed complications. This isn't about your anatomical knowledge or practice hours—expert clinicians fail too. David Olvera, who led national research on intubation checklists, reveals why your brain predictably fails under pressure and what systems actually prevent it. Yo...

Feeling Behind the Curve? Understanding the EMS Power Curve Will Help You Stay Ahead 26.01.2026

Behind the curve. We've all heard it. Most of us have lived it. That sinking feeling when you're mentally three steps behind where the call actually is. The concept of the Power Curve comes from aviation—pilots need to understand the phases of flight and how the plane will react differently and require different inputs during each of these phases. The same principle applies to your 911 calls. This...

Stupidity in EMS: The causes and remedies 13.01.2026

You're not making mistakes because you're dumb. You're making mistakes because of seven predictable factors—and once you know them, you can control them. Kris Kaull delivered a masterclass at FASTCAN on the hidden forces that cause even experienced paramedics to miss critical information when it matters most. This isn't about memorizing more protocols—it's about understanding the cognitive science...

Anaphylaxis + Asthma: When Standard Anaphylaxis Treatment May Not Be Enough (AMAX4 Explained) 17.12.2025

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 m...

The Habit Loop: How Master EMS Clinicians Build Unconscious Competence Through Habits 12.12.2025

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)...

Hypothermia Rescue: Cardiac Arrest in a Tree Well 03.12.2025

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 tr...

When The Anatomy Is Gone: Facial Trauma Airway Management 17.11.2025

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...

Stop Building Resilience, Strengthen Your Resistance 10.11.2025

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...

What If They Find Out I'm A Fraud? - Imposter Syndrome in EMS 03.11.2025

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 th...

Why Those With Addiction Don't "Just Change" - Opioid Crisis Reality for EMS 27.10.2025

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 challeng...

When to Act: Mastering Vasopressors in 2025 20.10.2025

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 fi...

The 5 Levels of EMS Mental Breakdown & How to Escape Them 13.10.2025

Why do some paramedics stay unshakable under pressure while others crumble on the exact same call? The answer isn't about years of experience—it's about understanding the neuroscience of stress and having the right mental tools.   Cody Winterford delivers an incredible breakdown of the five psychological "circles of hell" that providers face in high-stress situations. Starting with the amygdala hi...

Following Evidence or Following the Crowd? The Truth About Evidence-Based Medicine with Dr. Eddy Lang 06.10.2025

What if the evidence hierarchy you learned in school is incomplete? Dr. Eddie Lang, who helped develop the GRADE system now used by WHO and major resuscitation councils, explains why clinical practice guidelines—not RCTs or meta-analyses—should guide your practice decisions.   Join us at FASTCAN 25 as Dr. Lang, who's helped shap guidelines for the World Health Oganization (WHO) and the Internation...

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