Why did Nick switch to law enforcement? He burned out on medicine

What does he miss the most: The team mentality. The fire crews that he grew close to. He felt certain they could handle whatever call came their way

We talk about the struggles working a 48-hour shift with a rural fire department but also having to manage the expectation from the private ambulance company that you run calls in a much wider radius to include the city when needed

Sleep deprivation is a big factor in burnout

Nick talks about his heavy caffeine intake and how he started having runs of dysrhythmia that later required a cardiac ablation for atrial flutter

What does Nick not miss? Getting up to run calls. The tiredness. The anger and helplessness

I remember getting to my absolute wits end on those 48-hour shifts and having to call our supervisor and tell them we were done running calls because we were so tired

Nick talks about how he could feel that stress and sleep deprivation damaging him in real time, like if his hand was on fire

The stress level of running those calls an hour from the hospital with no other paramedic on scene and having to perform high level skills has not been matched as a PA in the ED

Nick talks about how, even in law enforcement, his fear of the next call is not equal to what it was as a paramedic

Brent talks about a time when Nick was so angry he started stabbing his seat belt

Don’t blame the patient for their medical emergencies and don’t take your frustrations out on them

Nick talks about losing his temper on an innocent dispatcher after a hard night

Why do we see more resiliency and less burnout on the fire side?

Maybe the team mentality on the fire department, ability to move to slower shifts, debriefing

We all tend to get support after that horrific call that makes the news, but a bigger problem might be the micro-traumas that we all undergo day in and day out

Resiliency needs to be built into the system – you are going to get burned out and have a tough day at some point and it needs to be prepared for

We don’t typically lie to ourselves that we are “okay,” we may genuinely feel okay. It’s later that situations and calls may

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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 ed...

Mark (paramedic) | Brent (fire officer and EMT) | Nick (former paramedic and current police officer)

Mark has worked in urban and very rural 911 ambulances and does part time EMT education now

Community paramedicine is an emerging field and can vary a lot from region to region. Paramedics are flexible providers, so the potential is huge

Brent has stuck with firefighting from his early days as a recruit all the way to becoming a fire officer

Nick has transitioned from EMS to law enforcement in the last several years

The history of the spine board is a good lesson for new people: The way we practice medicine is a constantly moving target. Best practice is not always based on good data. We used to put EVERYONE on a spine board, but this has turned out to likely be doing more harm than good

Even though logically something might make sense, it doesn’t mean it always does in reality. Backboards and epi are big examples of this

Mark talks about the history of backboards and how this practice came to be

An important point to remember in emergency medicine: If you have nothing really wrong with you, we are more likely to harm you than help you with treatment. This is because nothing comes without risk and if there is truly nothing to treat, the scale weighs entirely to the risk side.

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My favorite creatine supplement

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My favorite pre-workout supplement
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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 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 ed...

Nate talks about a motorcycle crash he stopped at on his way home and how he was critical in saving an injured patient and how he became close with the family who still talk to him today. Even though the patient ultimately died, the impact he made on that family was immense.

Patients remember us

We need to remember we treat a person not a complaint or a room number

The balance is finding the human connection while not over-empathizing and taking on burdens that are not yours to bare

We talk about moral injury vs burnout – I do agree that we do not need to blame the individual for their burnout. It is certainly caused from many factors outside of their control factor BUT I like to place the responsibility for overcoming burnout on the individual because no one is coming to save us. Looking to blame external factors doesn’t help us in the long run

Mental health struggles are not always obvious to us in people we spend time with

Casey talks about how the cooperate leaders are actually trying to do the right thing for the front-line workers in spite of what we might think about them

What advice for yourself 5-10 years ago?

Nate: Slow down. Listen to those with experience. Bring your love of the job to someone else, especially new people.

Kash: Remember that you don’t have to do everything on your own. EM is a team sport.

Aaron: Enjoy teaching the newbies. You can make or break their experience based on your affect.

Casey: Journal your days in EMS. The babies you deliver. The skills you perform. Something to look back on can be very valuable.

We mean a lot to new people and students so remember the influence you have on people

Support the show

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My favorite creatine supplement

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My favorite pre-workout supplement
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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 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 ed...

The paradigm around rapid sequence intubation is evolving and becoming much safer with more education and procedures.

Sometimes in emergency medicine slow is better. We need to stay mindful and calm in chaos and this requires us to detach and be above the fray and walk slowly instead of run. This will actually increase effectiveness and efficiency.

Nate recounts his EMT rides with myself and a great paramedic partner I had named Justin

Nate actually paid in EMT school to do more third rides so he could learn from the crews that were good at teaching

Crews can make or break an EMT students experience

Nate talks about how you really have to love EMS. The things we see are difficult, the shifts are long, the pay is not great. Something has to get you through

What affects one person may not affect another.

Casey talks about how it can be tough when things don’t affect you at all. That can be a form of struggle as well.

We talk about some of the hardest things to see in EMS, the cries of a mother or father at the loss of a child.

I talk about, how as an ER PA, I am a little more insulated from the death and the conversations with family than I was as a paramedic.

Nate talks about looking for the good differences you make with people. His job is not to save a life but to prolong lives.

Be intentional about marking those good moments

Casey talks about how a patients family remembered him long after a call

Support the show

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My favorite creatine supplement

https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS

My favorite pre-workout supplement
https://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 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 ed...

EMS varies significantly from state to state so you get a wide range in the abilities of EMT’s and paramedics nation wide

Case reviews are moving to an educational rather than a punitive model

There is no true national standard for EMT’s and paramedic’s which further complicates things

The regions that EMS is practiced in vary a ton as well. Skills may need to be performed much more frequently in an urban area vs a very rural area

Senior, experienced providers should use opportunities to show the newbies how to do skills rather than perform them themselves

One of the hardest parts of being a paramedic is standing back and delegating instead of doing the actual skills

EMS still falls under the department of transportation which is the department it was founded under

Standardization nationwide for EMS practice is difficult for multiple reasons, a big one is EMS needs and patients can vary a lot from region to region. Call volumes are very different from region to region.

Support the show

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My favorite creatine supplement

https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS

My favorite pre-workout supplement
https://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 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 ed...

Meet our new panel

Kash (EM physician)

Casey (Paramedic)

Nate (EMT)

Why emergency medicine?

Kash: Likes to see results in the short term rather than manage long-term problems. Decided on EM and even an EMS fellowship before starting med school after getting his EMT

Aaron: When in PA school you really need to be at least considering primary care but I decided it was not for me. A day in primary care tended to really drag for me while emergency medicine makes the day go by quickly

Nate: Initially wanted to be a firefighter but enjoyed the medical side more and eventually got his EMT. He loves the diversity of the patients and the chance to help people. He loves critical care transport with the increased knowledge he has gained

Nate: Learn to slow down.

Kash: Don’t just do something, stand there.

Fix the underlying issue. Don’t just blindly treat numbers. Fix the why, don’t just react.

Casey talks about a scenario where slowing down was critical to catching important details during an RSI. Sometimes the whole team gets so focused on individual tasks that simple things (like low O2 sats) can get missed.

Checklists can be critical to making sure the simple doesn’t get missed

We all need to have humility

I address the video that got taken out of context after people thought we were directly comparing EMT’s to CNA’s. That was definitely not the intent.

Nate talks about how he is proud and protective about what we do in EMS

Support the show

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My favorite creatine supplement

https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS

My favorite pre-workout supplement
https://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 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 ed...

Matt talks about our reliance on technology and how sometimes it is nice to remember that to assess a patient it is actually really simple without using technology

Andrew: I am mostly paid to not get tricked into missing something big.

Standards in medical education changing when there is emphasis on getting people through programs

Keep holding high standards for your students

Advice for the newbies:

Andrew: You won’t fail if you are trying your best and making the best decisions you can and caring for the patient

Aaron: Take care of yourself before you take care of patients

Matt: Ask for help if you need it.

Julie: Be content with where you are at

Sarah: Progress further in medicine if you can do it

Schasny: Don’t listen to the naysayers. Zero to hero is possible because everyone is different

You can learn from all providers, even if they haven’t been in the field long. Sometimes experience can be greatly varied even with only a short amount of time in the career

Support the show

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My favorite protein:
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My favorite creatine supplement

https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS

My favorite pre-workout supplement
https://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 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 ed...

Imminent baby delivery stories

Burnout tips: avoid the overtime. Sometimes the extra money is not worth the additional life stress.

Make sure you get off on time and make that transition to home life.

Andrew uses audio books so he has something to look forward to while driving to and from shift.

Patients are often not even the source of our stress, it’s operational difficulties, interpersonal difficulties and decision fatigue.

Decision fatigue is a big issue we face in our home lives after a significant portion of our day being in fight and flight mode

We talk about driving lights and sirens to every call and the dangers associated with this to the crew and public

This likely doesn’t save lives in any meaningful way that justifies the danger

There is a big push to decrease the emergent responses

We talk about the hazards with emergent returns, the confusion other drivers may have, the danger for the patient and crews.

Road rage isn’t worth engaging in, remember that the bar to obtain a drivers license is very low and many of the meth-using patients we take care of will drive as well. You never know what kind of person is in that other car.

I bring back up the discussion of “Where is God is emergency medicine?”

We see the whole spectrum of life and death. We see people come back from the brink of death that logically shouldn’t and those that succumb that logically shouldn’t.

We talk about strategies to compartmentalize and move on to the next patient

Schasny talks about the traumatic life and medical experiences she has come through and how they have changed her view on religion

Support the show

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My favorite protein:
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My favorite 1ST Phorm Energy Drinks:

https://1stphorm.com/products/1st-phorm-energy/?a_aid=PracticalEMS

My favorite creatine supplement

https://1stphorm.com/products/micronized-creatine-monohydrate/?a_aid=PracticalEMS

My favorite pre-workout supplement
https://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 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 ed...