The Inflection Point: Conversations in Care, Culture and Change. Designed for Paramedics.

About Dr. Joseph Cafazzo Dr. Cafazzo is the Executive Director of Biomedical Engineering and Health Systems at UHN and the founder of Healthcare Human Factors, North America’s largest health-focused human factors team. He is also a Professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation (IHPME), where he trains future healthcare leaders in system design and q...

In this special episode, we sit down with Marc Goudie, the Chief of Frontenac Paramedics. About Chief Marc Goudie: Chief Goudie holds multiple graduate degrees, including a Master of Health Management from McMaster University and a Master of Arts in Disaster and Emergency Management from Royal Roads University. He brings a wealth of clinical, academic, and strategic leadership experience to his ne...

About Dr. Joseph CafazzoDr. Cafazzo is the Executive Director of Biomedical Engineering and Health Systems at UHN and the founder of Healthcare Human Factors, North America’s largest health-focused human factors team. He is also a Professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation (IHPME), where he trains future healthcare leaders in system design and qu...

In this video, we delve into the challenges and best practices for treating COPD patients in pre-hospital settings. We discuss the daily struggles of COPD patients, the use of medications like Salbutamol and Dexamethasone, and the importance of early steroid administration to reduce hospitalizations and improve outcomes. The video also addresses the myths and realities of oxygen therapy, the signi...

In this video, we dive deep into Chronic Obstructive Pulmonary Disease (COPD), exploring its pathophysiology, prevalence, and management, particularly for paramedics. The conversation covers the factors contributing to COPD, including smoking and inflammatory responses, as well as the differentiation between chronic bronchitis and emphysema. We discuss the significance of early smoking cessation a...

In this episode, we dive into the intricacies of managing status epilepticus in prehospital settings. We discuss the significant risks associated with delayed or underdosed benzodiazepines, and the evolving guidelines that now define status epilepticus as a seizure lasting more than 5 minutes or multiple seizures without full recovery. Experts explore the pros and cons of ketamine as an adjunctive...

In this episode, we delve into seizure management for pre-hospital settings, beginning with a detailed case study of a 67-year-old male experiencing his first seizure. The discussion covers differential diagnoses, including the use of the 'VITAMINS' acronym to identify potential causes, ranging from infections to metabolic issues. Key seizure management strategies are outlined, emphasizing...

About Dr. Callum:https://research.sunnybrook.ca/researchers/jeannie-callum/https://pathology.queensu.ca/faculty-staff/jeannie-callumhttps://www.researchgate.net/profile/Jeannie-Callumhttps://www.youtube.com/watch?v=paAvUuXDChU&t=962s In this insightful part 2 episode, we explore the critical importance of temperature management and the timely administration of Tranexamic Acid (TXA) for trauma...

Dr. Jeannie Callum: The Architect of Prehospital TXA in OntarioWhat does it take to change an entire province’s approach to trauma care? For Dr. Jeannie Callum—hematologist, transfusion medicine specialist, and researcher—it took relentless advocacy, bold data, and a vision for saving lives before patients even reach the hospital. Known internationally for her expertise in bleeding disorders and t...

In this second episode, we delve into the crucial role of psychological safety within medical teams, particularly in high-stress environments like trauma care. The discussion highlights the importance of the phrase 'What else am I missing?' as a tool for team leads to flatten hierarchies and encourage open communication. Case studies, such as Elaine Bromley's tragic story, are explored to underlin...

In this episode, we delve into the PACKMaN trial, a recent study comparing ketamine and morphine for the treatment of traumatic pain. The discussion covers critical appraisal methods, study methodologies, sample size considerations, and the implications of the study's findings for paramedic practice in Ontario. We also explore the side effects, patient populations, and operational contexts in whic...

In this episode, we dive deep into the life-saving benefits of Tranexamic Acid (TXA) for trauma patients. We discuss what TXA is, how it works, and why it is considered one of the safest and most effective drugs in critical care. Join us as we explore the evidence supporting its use, common concerns, contraindications, and the importance of timely administration. Whether administered intravenously...

This is a clip from our first podcast episode. In this powerful episode, Dr. Andrew Petrosoniak shares what it takes for trauma teams to perform under extreme pressure. From human factors to psychological safety, this conversation dives deep into how elite medical teams make decisions, stay focused, and save lives—even in total chaos.🎯 Topics covered:High-stakes decision-making in trauma careBuil...

In this episode, Dr. Andrew Petrosoniak, an emergency and trauma doctor at St. Michael's Hospital in Toronto and Medical Director at Unity Health, shares his expertise in optimizing team performance in high-stress situations. He discusses the importance of designing systems that promote correct actions, the lessons learned from his work in simulation and design, and the value of borrowing strategi...

Justin is an Advanced Care Paramedic and researcher with Peel Regional Paramedic Services, a member of the Department of Family and Community Medicine at the University of Toronto, and a Scientist with the McNally Project for Paramedicine Research. His work focuses on psychological health and safety among paramedics. Justin is the research lead of the External Violence Against Paramedics (EVAP) pr...

About Justin: Justin is an Advanced Care Paramedic and researcher with Peel Regional Paramedic Services, a member of the Department of Family and Community Medicine at the University of Toronto, and a Scientist with the McNally Project for Paramedicine Research. His work focuses on psychological health and safety among paramedics. Justin is the research lead of the External Violence Against Parame...

In this episode, we delve into the best practices for intubation and the administration of epinephrine during emergency scenarios. Our discussion focuses on avoiding the use of epinephrine through the ETT, the importance of IV and IO routes, the benefits of video laryngoscopy, and the significance of preparation and teamwork. We also touch on airway management challenges, especially in cases with...

In this podcast episode, we dive deep into pre-hospital management strategies for drowning incidents, focused on both adult and pediatric patients. We explore the critical differences between drowning in cold and warm water, the impact of these factors on patient outcomes, and key considerations for initial resuscitation. The discussion covers scene safety, airway management, the effectiveness of...

In this comprehensive episode, we delve into the nuances of post-arrest care, focusing on the role of epinephrine, the importance of 12-lead ECG timing, and understanding false positives. The discussion covers essential post-resuscitation strategies, optimizing patient outcomes, and effective communication during patient handover. We also explore the ongoing changes in post-arrest care, including...

In this episode, Jakob and I dive into the complexities of managing post-arrest patients. We discuss the critical shift in mindset required once a pulse is regained and emphasize the importance of preventing secondary injuries before transport. Key topics include the priorities in post-arrest care, the role of vital signs, the use of dopamine for treating hypotension, and the ideal oxygen saturati...

In this episode, Jakob and I discuss handling pediatric patients in shockable rhythms, including calculating defibrillation dosages—2 joules per kilogram for the first shock and 4 joules per kilogram for subsequent shocks. We delve into antiarrhythmic medications, highlighting that amiodarone and lidocaine are considered equivalent and outlining their dosages. The importance of family presence and...

In this episode, Jakob and I delve into essential aspects of pediatric cardiac arrest management. Key topics include the importance of on-scene resuscitation, differences in pediatric versus adult cardiac arrest causes, optimal treatment strategies, and best practices for airway management. We'll also discuss the significance of early epinephrine administration and the current evidence on supraglo...

This video explores the critical aspects of pre-hospital airway management, emphasizing the importance of oxygenation and the variables affecting intubation success. The discussion covers systematic reviews, the pros and cons of endotracheal tubes versus SGAs in managing brain injuries, and the latest recommendations from medical guidelines. It highlights the benefits of simulation training in imp...

In this episode, we delve into Jakob's master thesis comparing the first pass success rate and overall success rate of laryngoscopy with video laryngoscopy for intubation by ACPs. The discussion covers the importance of advancing airway management, the challenges faced by paramedics in pre-hospital settings, educational and systemic interventions to improve first pass success rates, and the future...

Join us as Jakob and I delve into the complexities of pediatric sepsis in this informative podcast episode. We cover essential topics, including the mean arterial pressure targets for fluid and vasopressor administration, the appropriateness of vasopressors in pre-hospital settings, and the impact of socioeconomic status on sepsis outcomes. Learn about the critical differences between sepsis and s...