EMS is notorious for the high stress, long hours, and repeated exposure to trauma that leave an alarming number of burned-out professionals in its wake. Whether you work for a private ambulance, fire department, or in a hospital setting, burnout is a real and pervasive threat to the well-being of any EMS provider. And, where burnout is often found, so is a toxic workplace. In this episode, Steve, Dan, and Holly talk about their experiences in toxic environments or around toxic individuals. They discuss how easy it is to become part of the toxic culture, and why that makes it crucial to recognize associated patterns of thoughts and behavior and rise above them. The team then walks through steps to prevent becoming entrenched in the thoughts and behaviors that lend themselves to toxicity. This episode provides an opportunity to reflect both on one’s environment and to look inward to examine if there are aspects of toxicity that have crept into our thoughts and practices. It also gives helpful tools to self-correct to preserve our mental health and support and improve our department’s culture.

References:

1. Sutton, R. I. (2007). The no asshole rule: building a civilized workplace and surviving one that isn’t. https://ci.nii.ac.jp/ncid/BB0417406X
2. Ahmed, A. K., Atta, M. H. R., & El-Monshed, A. H. (2024). The effect of toxic leadership on workplace deviance: the mediating effect of emotional exhaustion, and the moderating effect of organizational cynicism. BMC Nursing, 23, Article 669.

In this episode, Steve, Dan, and Holly are back in the studio as Holly leads the team through an in-depth discussion on the trauma death triad (diamond). They discuss each component – hypothermia, acidosis, coagulation – and that tricky final component that plays a role in all three, calcium. Holly provides a scientific breakdown of each component, and then the team discusses the practical implications of each component in the “real-life” management of a trauma patient in the field.  Holly also touches on some longer-term implications of trauma management for those providers who end up on scene with a patient for longer than they bargained for or who provide an interfacility transfer for a patient a few days after their initial incident.

This episode provides helpful insight for all providers in both the initial and ongoing assessments of any patient who has experienced a massive trauma, and what we can do in the field to mitigate mortality and positively impact their overall outcomes.

References

1. Aynalem, M., Shiferaw, E., Gelaw, Y., & Enawgaw, B. (2021). Coagulopathy and its associated factors among patients with a bleeding diathesis at the University of Gondar Specialized Referral Hospital, Northwest Ethiopia. Thrombosis journal, 19(1), 36. https://doi.org/10.1186/s12959-021-00287-6
2. Chanthima, Phuriphong MD*; Yuwapattanawong, Kornkamon MD*; Thamjamrassri, Thanyalak MD*; Nathwani, Rajen MBBS†; Stansbury, Lynn G. MD*,†; Vavilala, Monica S. MD*,†; Arbabi, Saman MD*,‡; Hess, John R. MD, MPH, FACP, FAAAS*,§. Association Between Ionized Calcium Concentrations During Hemostatic Transfusion and Calcium Treatment With Mortality in Major Trauma. Anesthesia & Analgesia 132(6):p 1684-1691, June 2021. | DOI: 10.1213/ANE.0000000000005431
3. Dupuy, C., Martinez, T., Duranteau, O., Gauss, T., Kapandji, N., Pasqueron, J., … & TraumaBase Group®. (2025). Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort. World Journal of Emergency Surgery, 20(1), 2.
4. Fort, A. C., & Dudaryk, R. (2021). Evolving science of trauma-induced coagulopathy. International Anesthesiology Clinics., 59(2), 25–30. https://doi.org/10.1097/AIA.0000000000000318
5. Mills, J. D. (2024). Trauma Diamond of Death: Adding Calcium to the Lethal Triad. Journal of Emergency Nursing, 50(3), 330-335. https://doi.org/10.1016/j.jen.2023.12.011
6. Latif, R.K., Clifford, S.P., Baker, J.A. et al. Traumatic hemorrhage and chain of survival. Scand J Trauma Resusc Emerg Med 31, 25 (2023). https://doi.org/10.1186/s13049-023-01088-8
7. Savioli, G., Ceresa, I. F., Caneva, L., Gerosa, S., & Ricevuti, G. (2021). Trauma-Induced Coagulopathy: Overview of an Emerging Medical Problem from Pathophysiology to Outcomes. Medicines, 8(4), 16. https://doi.org/10.3390/medicines8040016
8. The American Association for the Surgery of Trauma. (n.d.). Trauma facts. https://www.aast.org/resources/trauma-facts

See Holly’s slides below!

Trauma Death Triad_PDF

In this episode, Steve, Dan, and Holly are joined by guest Matt Shamrell, a burn unit ICU nurse. Matt discusses treatment processes for burn patients, including fluid resuscitation, pain management, and wound care. Matt answers questions about risk factors for, and the in-hospital management of, compartment syndrome as well as the potential for severe and life-threatening infections in burn patients. The team discusses how EMS providers can best treat burn patients to ensure the transition of care from pre-hospital to in-hospital is as seamless as possible.

Steve and Dan co-host their first show without Holly as they welcome special guest Eric Jaeger. Eric is an RSI Paramedic and Attorney from New Hampshire who leads the discussion on best practices for physical restraint and chemical sedation and the legal ramifications these interventions carry. Eric shares his knowledge of the tragic circumstances surrounding George Floyd and Elijah McClain’s deaths and discusses improvements to consider when it comes to protocols and guidelines for these procedures.

In today’s episode, Steve, Dan, and Holly have the opportunity to discuss an interesting MCI call with guest, Firefighter/Paramedic Kyle Snider. At the time of the incident, Kyle was a new paramedic graduate with wilderness medicine training who was working in a rural department with limited resources. Kyle discusses the call from the point of dispatch to call completion and reviews what he felt went well and what he would have changed. This episode gives the team a chance to discuss how we often leave chaotic scenes feeling overwhelmed and discouraged; however, reviewing the call with others in the field can be helpful to see where we performed well and where or what we could do to make improvements if faced with a similar call in the future. When discussing this call, we see how Kyle managed as the PIC and only paid medic while ensuring all patients received care. He then took what he learned from this call to help make personal and departmental improvements moving forward.