MCHD Paramedic Podcast

Epizode

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  Episode 197 - Altered Mental Status - The Next 30 Minutes 10.08.2026 46min

  We're going to take our "Serial Killers" series and continue into the transition from the ambulance to the emergency department. What happens to the patient with an altered patient once the ER doctor takes over? How does the workup advance? What imaging is ordered? What labs? Join us to discuss the "next 30 minutes" for the serial killer AMS patient.
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  Episode 196 - Cervical Spine Immobilization In 2026: Evidence Vs. Dogma 13.07.2026 26min

  We recently made some cervical spine immobilization protocol changes here at MCHD. Dr. Patrick and Dr. DePasquale discuss the history and literature that provide the foundation for rigid cervical collar use, along with the new MCHD protocol implementation. This has been a collaborative process with our local hospital partners, which has definitely involved give-and-take on both sides. REFERENCES 1. Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury. 1996 Nov;27(9):647-9. 2. Mobbs RJ, Stoodley MA, Fuller J. Effect of cervical hard collar on intracranial pressure after head injury. ANZ J Surg. 2002 Jun;72(6):389-91. 3. Hunt K, Hallworth S, Smith M. The effects of rigid collar placement on intracranial and cerebral perfusion pressures. Anaesthesia. 2001 Jun;56(6):511-3. 4. Lerner EB, Billittier AJ 4th, Moscati RM. The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects. Prehosp Emerg Care. 1998 Apr-Jun;2(2):112-6. 5. Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Prehosp Emerg Care. 1999 Oct-Dec;3(4):347-52 6. Mitra B, Bernard S, Yankoff C, Somesh A, Stewart C, Koolstra C, Talarico C, Nehme Z, Fitzgerald MC, Cameron PA. Change from semi-rigid to soft collars for prehospital management of trauma patients: An observational study. J Am Coll Emerg Physicians Open. 2024 Jul 17;5(4):e13239. 7. Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014 Mar 15;31(6):531-40. 8. Millin MG, Innes JC, King GD, Abo BN, Kelly SM, Knoles CL, Vezzetti R, White CC 4th, Yee A, Gallagher JM. Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries - A NAEMSP Comprehensive Review and Analysis of the Literature. Prehosp Emerg Care. 2025 Aug 7:1-13. 9. Ramasamy A. Advanced trauma life support 2025: A brief review of updates. Injury. 2026 Apr;57(4):113079. doi: 10.1016/j.injury.2026.
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  Episode 195 - Cold Water Immersion For Heatstroke - Lessons From Phoenix 15.06.2026 41min

  Drs. Geoff Comp and Jerry Snow join the podcast to discuss their recent paper describing their experience treating undifferentiated heatstroke in Phoenix with cold water immersion. Their protocol mirrors ours here in Montgomery County. Heatstroke is a time-sensitive emergency, and the rate of cooling directly correlates with mortality reduction. Learn how to implement CWI in your service. It's the best of all worlds: inexpensive, impactful, and applies to all EMS clinician levels. REFERENCES 1. Comp G, Finch C, Kupanoff K, Sandoval M, Lloyd M, Aldaco N, Kirk D, Pugsley P, Nordstrom L, Koenig BW, Narang A, Snow J, Kamer M, Foster A, Patel G, Stowell JR. Fighting Fire with Ice: A Multisite Collaboration to Evaluate the Impact of Prehospital Cold Water Immersion on Heat Stroke Patients. Prehosp Emerg Care. 2026 Mar 13:1-11.
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  Episode 194 - Mental Health Matters In EMS With Dr. Joe Gill 18.05.2026 38min

  MCHD's Spencer Lantz and Fort Bend County EMS Medical Director, Dr. Gill join the podcast to discuss the importance of allowing an open conversation around the mental health issues and strain of being an EMS clinician. We've finally started to recognize the issue, Spencer and Dr. Gill have some concrete solutions for the future.
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  Episode 193 - What Can EMS Learn From An Emergency Pharmacist? - Part 2 20.04.2026 31min

  One of our major 2026 clinical and educational focus areas here at MCHD is medication error reduction. While medication errors are complex and have no simple solution, recognizing the issue is the initial step in changing culture. We're lucky to have a special guest with a unique perspective on this episode. Kevin Mercer, an emergency department pharmacist, joins Dr. Patrick to discuss all things medication administration. This is the second episode of our two-part series! REFERENCES 1. Harmer BM, Hoyle JD Jr, Edwards A, Fredericks T, Wells L, Lecznar A, Christopher K, Dunwoody S, Hong G, Rantz W, Popov V, Mahajan P, Fogarty K. Assessing the Influence of a Statewide Dosing Reference Aid on Prehospital Pediatric Medication Dosing Errors: A Mixed-Methods Simulation-Based Investigation. Prehosp Emerg Care. 2026 Mar 9:1-8.
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  Episode 192 - What Can EMS Learn From An Emergency Pharmacist? - Part 1 23.03.2026 30min

  One of our major 2026 clinical and educational focus areas here at MCHD is medication error reduction. While medication errors are complex and have no simple solution, recognizing the issue is the initial step in changing culture. We're lucky to have a special guest with a unique perspective on this episode. Kevin Mercer, an emergency department pharmacist, joins Dr. Patrick to discuss all things medication administration. The episode went so well, we had to create a two-part series! REFERENCES 1. Harmer BM, Hoyle JD Jr, Edwards A, Fredericks T, Wells L, Lecznar A, Christopher K, Dunwoody S, Hong G, Rantz W, Popov V, Mahajan P, Fogarty K. Assessing the Influence of a Statewide Dosing Reference Aid on Prehospital Pediatric Medication Dosing Errors: A Mixed-Methods Simulation-Based Investigation. Prehosp Emerg Care. 2026 Mar 9:1-8.
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  Episode 191 - EMS Protocols 101 23.02.2026 36min

  As discussed on prior episodes, we recently overhauled our entire protocol structure here at MCHD. One of our MCHD paramedics, David Lozano, joins us to discuss the foundations of EMS protocol creation. Who writes them and how? Where are the potentially risky decisions? What should the MCHD field paramedics know about the process? Have a listen to better understand the true foundation of EMS clinical practice.
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  Episode 190 - Geriatric Considerations In EMS With Dr. Maia Dorsett 26.01.2026 49min

  The most common podcast requests over the past couple of years have been focused on prehospital geriatric care. Dr. Maia Dorsett, EMS geriatric expert, joins us to discuss pearls and pitfalls when caring for elderly patients in the prehospital setting. What are the common mistakes? What tools can be implemented to improve patient outcomes? Why does geriatric care even matter? This episode is packed with high-yield information that will make all of us better clinicians. REFERENCES 1. Dorsett M, Allen H, Garbacz H, Sensenbach B, Kumar S, Jones CMC, Cushman JT. Timeline for Repeat EMS Encounters Resulting in Transport Following "Lift Assist" in a Suburban EMS System. Prehosp Emerg Care. 2025 May 29:1-6. 2. Haussner WK, Breyre AM, Bascombe K, Barrett WJ, Camacho MA, Overton-Harris P, Williams S, Lyng JW, Martin-Gill C, Colwell C. Prehospital Trauma Compendium: Management of Geriatric Trauma Patients - A Position Statement and Resource Document of NAEMSP. Prehosp Emerg Care. 2025 Sep 25:1-10.
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  Episode 189 - EMS Airway Updates 2025 - Part 2 29.12.2025 29min

  There are always airway management questions floating around the Department of Clinical Services here at MCHD. "Why can't we take a look after sedation only?" "Why doesn't MCHD have a crash airway protocol?" Join the podcast crew to discuss recent EMS airway literature that helps us answer these questions and provides invaluable tips. This is part two of a two-part series. REFERENCES 1. Jarvis JL, Jarvis SE, Kennel J. The Association Between Out-of-Hospital Drug-Assisted Airway Management Approach and Intubation First-Pass Success. Ann Emerg Med. 2025 Nov;86(5):521-530. 2. Spigner MF, Wang HE, Carlson JN. One and Done? Rethinking "First-Pass Success" in Out-of-Hospital Airway Management. Ann Emerg Med. 2025 Nov;86(5):531-532. 3. Maia IWA, Besen BAMP, Silva LOJE, et al; BARCO group. Peri-intubation adverse events and clinical outcomes in emergency department patients: the BARCO study. Crit Care. 2025 Apr 17;29(1):155.
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  Episode 188 - Prehospital OB Updates 2025 01.12.2025 29min

  Recently, some paramedics, obstetricians, and EMS medical directors were locked in a room and produced some fantastic collaborative prehospital guidelines for managing post-partum hemorrhage, eclampsia, and pre-eclampsia. Have a listen, take a look at the guidelines (links below), and we'll all take better care of our pregnant/post-partum patients. REFERENCES 1. https://naemsp.org/news/now-available-new-ems-obstetric-emergency-guidelines/
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  Episode 187 - EMS Airway Updates 2025 - Part 1 03.11.2025 26min

  There are always airway management questions floating around the Department of Clinical Services here at MCHD. "Why don't we intubate our cardiac arrest patients like we used to?" "MCHD has been hyper-focused on recording video laryngoscopy over the past year. Why?" Join the podcast crew to discuss recent EMS airway literature that helps us answer these questions and provides invaluable tips. This is part one of a two-part series. REFERENCES 1. Galinski, M., Tazi, G., Wrobel, M., Boyer, R., Reuter, P. G., Ruscev, M., Debaty, G., Bagou, G., Dehours, E., Bosc, J., Lorendeau, J. P., Goddet, S., Marouf, K., Simonnet, B., & Gil-Jardiné, C. (2025). Risk factors for failure of the first intubation attempt during cardiopulmonary resuscitation in out-of-hospital emergency settings: What about chest compression?. Resuscitation, 214, 110623. 2. Brenne, N., Brünjes, N., Rupp, D., Sassen, M. C., Jerrentrup, A., Wulf, H., Heuser, N., & Volberg, C. (2025). Success of airway management in out-of-hospital cardiac arrest using different devices - a prospective, single-center, observational study comparing professions. Scandinavian journal of trauma, resuscitation and emergency medicine, 33(1), 109. 3. Bryan, A., Feltes, J., Sweetser, P. W., Winsten, S., Hunter, I., & Yamane, D. (2025). Hyperangulated video laryngoscopy in the emergency department: An analysis of errors and factors leading to prolonged apnea time. The American journal of emergency medicine, 95, 153–158.
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  Episode 186 - A Paramedic's Guide To The Opiate Epidemic 06.10.2025 31min

  We're lucky to have a special guest on this podcast episode to discuss a topic that, unfortunately, all of us in emergency care encounter all too frequently: the opiate epidemic. Peter Canning is a paramedic who has lived through the epidemic while working on the ambulance in the New England epicenter. This discussion navigates Peter's progression through newer terminology like stigma and harm reduction in an effort to provide compassionate and best-practice care for our OUD patients. REFERENCES 1. https://www.press.jhu.edu/books/title/12438/killing-season?srsltid=AfmBOopOX3Wpf9blJDuiJbwOCKyNCACoxU2IixIMtLg1N1a-wYTGeEmr 2. https://www.press.jhu.edu/books/title/53796/friends-and-family-guide-opioid-overdose-epidemic
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  Episode 185 - Chest Pain - The Next 30 Minutes 09.09.2025 43min

  We're going to take our "Serial Killers" series and continue into the transition from the ambulance to the emergency department. What happens to the patient with chest pain once the ER doctor takes over? How does the workup advance? What imaging is ordered? What labs? Join us to discuss the "next 30 minutes" for the serial killer chest pain patient.
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  Episode 184 - Recording Video Laryngoscopy In EMS 11.08.2025 30min

  On this episode, the podcast crew discusses the recent introduction of video laryngoscopy with recording capability at MCHD. What device did you use? How did you train? What lessons have you learned? All these and more will be addressed and answered. REFERENCES: 1. Zhao, Y., Zang, B., & Wang, Q. (2024). The Effectiveness of Bougie Use on First-Attempt Success in Tracheal Intubations. Annals of emergency medicine, 84(3), 331–332. 2. Weingart, S. D., Barnicle, R. N., Janke, A., Bhagwan, S. D., Tanzi, M., McKenna, P. J., Bracey, A., & Resuscitationists Research Group (2023). A taxonomy of key performance errors for emergency intubation. The American journal of emergency medicine, 73, 137–144.
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  Episode 183 - Pain Control In EMS - The MCHD Analgesia Ladder 14.07.2025 19min

  The podcast crew takes on the topic of prehospital analgesia. What pain medication do we choose when facing a complex patient with all analgesics available? Are there better options for hypotensive patients? What about pregnancy and the elderly? On this episode, we'll walk through our MCHD pain medication options, take a moment for a BLS reminder, and discuss some specific situations where certain medications are the best fit. REFERENCES 1. McArthur, R., Cash, R. E., Rafique, Z., Dickson, R., Crocker, K., Crowe, R. P., Wells, M., Chu, K., Nguyen, J., & Patrick, C. (2024). Intravenous Acetaminophen Versus Ketorolac for Prehospital Analgesia: A Retrospective Data Review. The Journal of emergency medicine, 67(3), e259–e267. 2. McArthur, R., Cash, R. E., Anderson, J., De La Rosa, X., Peckne, P., Hogue, D., Badawood, L., Secrist, E., Andrabi, S., & Patrick, C. (2025). Fentanyl versus nebulized ketamine for prehospital analgesia: A retrospective data review. The American journal of emergency medicine, 89, 124–128. 3. Powell, J. R., Browne, L. R., Guild, K., Shah, M. I., Crowe, R. P., Lindbeck, G., Braithwaite, S., Lang, E. S., Panchal, A. R., & Technical Expert Panel (2023). Evidence-Based Guidelines for Prehospital Pain Management: Literature and Methods. Prehospital emergency care, 27(2), 154–161. 4. Aceves, A., Crowe, R. P., Zaidi, H. Q., Gill, J., Johnson, R., Vithalani, V., Fairbrother, H., & Huebinger, R. (2023). Disparities in Prehospital Non-Traumatic Pain Management. Prehospital emergency care, 27(6), 794–799.
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  Episode 182 - Traumatic Arrest With The Prehospitalist 16.06.2025 40min

  Lindsey Ewing (IG's The Prehospitalist) joins us to discuss updates and questions surrounding the EMS management of traumatic arrest. Sure, we must address the "reversible" causes, but what about ACLS/compressions/epinephrine? Which patients are exceptions to the rules? Lindsey had a tough case, asked some hard questions, and will provide solid answers—our favorite recipe for a jam-packed educational session. REFERENCES 1. Witt, C. E., Shatz, D. V., Robinson, B. R. H., Campion, E. M., Shapiro, M. L., Bui, E. H., Meizoso, J. P., & Dorlac, W. C. (2025). Epinephrine in Prehospital Traumatic Cardiac Arrest-Life Saving or False Hope?. Prehospital emergency care, 1–9. 2. Breyre, A. M., George, N., Nelson, A. R., Ingram, C. J., Lardaro, T., Vanderkolk, W., & Lyng, J. W. (2025). Prehospital Trauma Compendium: Prehospital Management of Adults with Traumatic Out-of-Hospital Circulatory Arrest - A Joint Position Statement and Resource Document of NAEMSP, ACS-COT, and ACEP. Prehospital emergency care, 1–15. 3. https://www.anzcor.org/assets/anzcor-guidelines/guideline-11-10-1-management-of-cardiac-arrest-due-to-trauma-253.pdf
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  Episode 181 - Why You Should Attend The Resuscitation Academy 19.05.2025 37min

  We're joined by Dallas-area cardiac arrest management thought leaders from Best EMS and Parker County Hospital District to discuss the Resuscitation Academy. Where did this thing start? How can you and your service benefit? What RA lessons have we implemented here at MCHD? Learn how to improve your cardiac arrest survival rates without breaking the bank. REFERENCES 1. https://www.resuscitationacademy.org
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  Episode 180 - Orthostatic Vitals - Should They Stay or Should They Go? 21.04.2025 20min

  Orthostatic vitals are taught throughout medical training as a quick and easy way to assess patient volume status objectively. We also frequently see these documented in MCHD charts. Is there any evidence that orthostatics help our clinical decision-making? Has anyone ever evaluated their use in EMS? Could standing a patient to check their heart rate actually be harmful? Join the podcast crew as they address these questions and more. REFERENCES 1. White, JL, Hollander, JE, Chang, AM, et al. (2019). Orthostatic vital signs do not predict 30-day serious outcomes in older emergency department patients with syncope: A multicenter observational study. The American journal of emergency medicine, 37(12), 2215–2223. 2. Shen W, Sheldon R, Yancy C, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of The American College Of Cardiology. August 1, 2017;70(5):e39-e110. Available from: MEDLINE, Ipswich, MA. Accessed May 1, 2018. 3. Cohen E, Grossman E, Sapoznikov B, et al. Assessment of orthostatic hypotension in the emergency room. Blood Press. 2006;15(5):263-267. 4. Aronow WS, Lee NH, Sales FF, Etienne F. Prevalence of postural hypotension in elderly patients in a long-term health care facility. Am J Cardiol. 1988;62(4):336. 5. Ooi WL, Barrett S, Hossain M, et al. Patterns of orthostatic blood pressure change and their clinical correlates in a frail, elderly population. JAMA. 1997;277(16):1299-1304.
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  Episode 179 - Transcutaneous Pacing Pearls and Pitfalls 19.03.2025 38min

  On today's episode, we're lucky to have a couple of special guests to discuss prehospital transcutaneous pacing. Medics turned medical students and EMS researchers, Josh Kimbrell and Judah Kreinbrook recently published a case series decsribing EMS pacing capture. Like many of our favorite topics this came from a paramedic asking a clinical question with loads of dogma and little evidence. What they found should motivate us all to be skeptical when it comes to determining if TCP is actually working. REFERENCES 1. https://www.mchd-tx.org/media/podcasts/TCP-Podcast-Figures.pdf 2. Kimbrell, J., Kreinbrook, J., Poke, D., Kalosza, B., Geldner, J., Shekhar, A. C., Miele, A., Bouthillet, T., & Vega, J. (2024). False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehospital emergency care, 28(7), 928–936. 3. https://www.ems12lead.com/post/tcp-in-transit-part-i 4. https://www.ems12lead.com/post/transcutaneous-pacing-part-2 5. https://www.ems12lead.com/post/transcutaneous-pacing-part-3
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  Episode 178 - A STEMI Unlike Any Other 18.02.2025 21min

  We often discuss "one in a million" and "once in a career" cases in emergency medicine and EMS, and do we ever have one of those for you in this episode! MCHD Captain, Jason Jones, joins Dr. Patrick to discuss an exeedingly rare STEMI/chest pain presentation with lessons that we can all apply to our daily care. REFERENCES 1. https://www.mchd-tx.org/media/podcasts/SITUS-Fig-1.pdf 2. https://www.mchd-tx.org/media/podcasts/SITUS-Fig-2.pdf 3. https://montgomerycountypolicereporter.com/mchd-celebrates-survival-of-one-in-a-million-patient-first-responders-please-read/ 4. https://pubmed.ncbi.nlm.nih.gov/34317454/