Critical Levels

What is a paramedic — really? In this thought-provoking episode of Critical Levels, Zach sits down with Dr. Alan Batt to unpack the evolving identity, responsibilities, and future of the paramedic profession. Together, they explore the disconnect between what paramedics are trained for versus what they actually do, the consequences of outdated education models, and the urgent need for professionalization and system-level change. They discuss: * Why current training doesn’t match real-world workload * How we define scope, identity, and autonomy in modern paramedicine * The concept of career pathways beyond clinical work * What regulatory independence could look like * And why it might finally be time for paramedics to “move out of their parents’ basement” Whether you’re a frontline clinician, educator, leader, or student, this episode challenges assumptions and sparks a critical conversation about the future of paramedicine in Canada and beyond.

Neonates are one of the most feared patient populations in EMS—and for good reason. In this episode, Zach Cantor talks with Anthony Iacolucci, a pediatric respiratory therapist and paramedic, about how to confidently approach neonatal calls. Anthony introduces NEO SECRETS, a practical acronym covering the top 10 causes of neonatal illness, and offers insight into assessment, common pitfalls, and key treatment considerations. NEO SECRETS Breakdown:     •    N – Inborn errors of metabolism     •    E – Electrolyte abnormalities     •    O – Overdose or toxic exposure     •    S – Sepsis (the leading cause of neonatal mortality)     •    E – Endocrine crisis (e.g., hypoglycemia, adrenal insufficiency)     •    C – Cardiac conditions (cyanotic vs. acyanotic presentations)     •    R – Recipe or formula mishaps (e.g., dilution errors leading to hyponatremia)     •    E – Enteric emergencies (e.g., malrotation with volvulus, gastroenteritis)     •    T – Trauma, including accidental and non-accidental injuries     •    S – Seizures (often subtle and hard to recognize in neonates)   Key Takeaways:     •    Neonates are not small adults or even small pediatric patients—they are physiologically distinct and highly vulnerable.     •    Early identification of sepsis, cardiac issues, and metabolic errors can save lives.     •    Paramedics should rely on strong assessment skills, detailed history-taking, and high suspicion for uncommon causes.     •    Videos, glucose checks, pre-ductal saturations, and detailed caregiver interviews are essential field tools.     •    Understanding neonatal physiology, presentation timelines, and risk factors improves both confidence and outcomes.   Why Listen: If you’ve ever felt unprepared when faced with a neonatal call, this episode provides a clear, practical, and memorable guide to the top threats to neonates—and how to recognize and respond to them in the field.

In this episode of Critical Levels, we dive into the cutting-edge strategies shaping pre-hospital and emergency department care. Our guests discuss how data-driven decision-making, high-performance CPR, and improved handover processes are revolutionizing patient outcomes. Key Topics Covered: ✅ High-Performance CPR: The role of real-time feedback, mechanical CPR devices, and quality metrics in improving survival rates. ✅ Data-Driven Protocols: How data influences resuscitation techniques, including push-dose epinephrine, early vasopressor administration, and optimizing CPR pauses. ✅ Seamless Transitions of Care: Addressing the challenges of pre-hospital to hospital handover, minimizing interruptions, and ensuring continuity of life-saving interventions. ✅ Training & Coaching: The impact of structured CPR coaching, debriefing sessions, and real-time monitoring in refining paramedic performance. ✅ Future Directions: Exploring nurse-led ACLS, multidisciplinary teamwork, and technology-driven improvements in emergency medicine. Key Takeaways: 🔹 Data analysis is critical in refining protocols and enhancing patient survival. 🔹 Effective communication and structured handovers reduce adverse events. 🔹 Continuous training and feedback loops lead to better resuscitation outcomes. Join us as we explore how collaboration, innovation, and data are shaping the future of emergency medical care.

🔹 Key Topics: 🔸 Why medics need to understand K9 trauma care * The overlap between human and canine emergency medicine * Common injuries in police, military, and search-and-rescue dogs 🔸 MARCH for Canines—What’s Different? * The first "M" stands for Muzzle—securing the dog’s “weapon” before treatment * Understanding the similarities in trauma care between humans and dogs * Key differences in how canines respond to injury and shock 🔸 Massive Hemorrhage Control—Why Tourniquets Don’t Work on Dogs * Anatomical challenges—why dogs' limbs aren’t suited for tourniquets * When to use direct pressure, wound packing, and hemostatic agents * Junctional bleeding—where life-threatening hemorrhages happen in dogs 🔸 Airway & Breathing—Why Intubating a Dog Is Easier Than You Think * How to recognize respiratory distress vs. normal panting * Why dogs have larger, straighter airways than humans * Needle decompression for pneumothorax—landmarks and technique 🔸 Transporting an Injured K9—Avoid These Mistakes * Best positions and vehicles for safe transport * What paramedics, police, and handlers need to plan for before an emergency 🔸 Shock & Fluid Resuscitation—The Critical Role of Femoral Pulse Checks * How to assess perfusion in a dog without a blood pressure cuff * Why EZ-IO is the best choice for vascular access in canines * When and how to administer fluids, TXA, and blood products 🔸 CPR for Dogs—Does It Work? * When CPR can save a dog—and when it won’t * How to perform chest compressions correctly * Naloxone for K9 opioid overdoses—it works, but dosing is different 🔸 Medications & Pain Management—What Paramedics Can Safely Use * NSAIDs are dangerous for dogs—avoid them in trauma cases * Opioids, TXA, ketamine, and antibiotics—what’s safe and effective?

In this episode of Critical Levels, we tackle frostbite with Dr. Maria Doubova, exploring its pathophysiology, symptoms, and treatment. From outdoor enthusiasts to vulnerable populations, frostbite affects diverse groups. Learn about early early recognition and management of frostbite - from mild frostnip to severe cases requiring advanced interventions - and the latest classification system to improve outcomes in this insightful discussion.   What You’ll Learn in This Episode:   What frostbite is and who is most at risk. Symptoms and early detection techniques. Frostbite classifications and their significance for prognosis. Practical pre-hospital and hospital management strategies. How frostbite overlaps with hypothermia and what to watch for.