Behind the Protocols: A conversation with Dr. Nick Wleklinski

When it comes to obstetric emergencies, EMS providers aren't caring for one patient; they're caring for two. But when resources are limited, and decisions need to be made quickly, who comes first? The answer may be simpler than you think.In this month's episode of Back in Quarters, Dustin Weber and Stephanie Lehmann sit down with Nancy Patrick, Clinical Nurse Specialist for Women's and Children's Services at SSM Health, to discuss the unique challenges of managing obstetric emergencies in the prehospital setting. Together, they explore the critical concept that what's good for mom is usually good for baby, and how focusing on maternal airway, breathing, circulation, and overall stability often provides the best outcomes for both patients. The conversation covers practical assessment techniques EMS providers can use in the field, including recognizing placental abruption, evaluating maternal perfusion, understanding the effects of patient positioning, and identifying situations where the needs of mother and baby may diverge. The team also discusses trauma, cardiac arrest, prehospital deliveries, newborn resuscitation priorities, destination decisions, and common pitfalls EMS crews encounter when caring for pregnant patients. Along the way, you'll learn why a rigid uterus can be a red flag, why keeping newborns warm is one of the most important interventions you can provide, and why sometimes the most valuable thing a provider can do during an OB emergency is simply stay calm and return to the basics. Whether you've delivered dozens of babies or are still hoping your first field delivery happens on someone else's shift, this episode offers practical pearls and reassuring advice to help you confidently care for two patients at once.Listen in as we arrive Back in Quarters.

What do CPAP, BiPAP, and ventilators really do—and how do you know when to use each one in the field?In this episode of Back in Quarters, Dustin Weber sits down with Thomas Krueger, critical care nurse and paramedic, to break down respiratory distress in a practical, street‑level way. They explore the difference between oxygenation failure and ventilation failure, why BiPAP is a game‑changer in prehospital care, and how early use of positive pressure can change a patient’s trajectory.From subtle red flags like “I’m tired,” to choosing the right tool at the right time, this conversation focuses on clinical judgment, patient tolerance, and using positive pressure to stay ahead of respiratory failure—before it turns into an airway you don’t want to manage.

This month on Back in Quarters, Dustin and Stephanie sit down with the St. Mary’s Stroke Team to uncover what really happens behind the scenes when a stroke patient hits the door—and why EMS is the spark that sets the whole system in motion.From FAST-ED scores to “glorified plumbers,” we explore how field impressions shape hospital pathways, why a 20‑gauge IV above the wrist can change everything, and how advanced imaging (and even AI) is redefining stroke care.We also tackle the transport conundrum: nearest hospital or highest capability? rural vs. urban? snowstorm vs. sunshine?If you’ve ever wondered how your scene impression becomes a real-time surgical decision—or why over‑calling a stroke is basically a love language—this episode is for you.(Link for continuing education credit coming soon!)

What happens when EMS errors meet empathy? In this season opener of Back in Quarters, we sit down with Dr. Aurora Lybeck and Stephanie Lehman to unpack Just Culture—a philosophy that’s more than a checkbox on a training sheet. From medication mishaps to near-miss celebrations, we explore how shifting from blame to curiosity can transform teams, improve patient safety, and even turn mistakes into champions for change. If you’ve ever wondered how words like “violation” versus “inconsistent” can make or break trust, this episode is your wake-up call. Tune in and discover why Just Culture isn’t just policy—it’s the heartbeat of a healthier EMS system.

Every EMS provider has that call they replay intheir head on the drive back to the station: the surprise needle stick, the bloody splash to the eye, the coughing mystery illness in the back of the rig. In this episode of Back in Quarters, Dustin and Stephanie sit down with infectious disease physician Dr. Amanda Carlson and infection preventionist Lauren Watson to unpack what actually counts as an exposure, what makes it “significant,” and what happens next. They dig into real-world scenarios—needle sticks, respiratorypathogens, measles scares, meningitis, HIV, hep B and C—and walk through how risk is really assessed, why timing and reporting matter, and what the follow-up looks like. Most importantly, they talk about the part we don’t say out loud: the fear, the “what if I take this home?” worry, and how a whole behind-the-scenes team works to support EMS providers after an exposure. If you’ve ever gone home from shift quietly spiraling about a patient’s “unknown status,” this one’s your permission slip to stop suffering in your own head and use the resources that exist for you.

In this Back in Quarters episode, Dustin sits down with Dr. Kacey Kronenfeld, MD, an EMS & Emergency Medicine physician, to tackle a spicy idea that makes new providers sweat: sometimes the safest, most effective move is… not moving. They break down the art of intentional inaction—how to pause, reassess, and let physiology do some of the heavy lifting—without missing the moment when you should act. Through real-world cases they unpack when interventions backfire, how to communicate “we’rewatching on purpose,” and why protocols are frameworks, not handcuffs. Who it’s for:EMTs, paramedics, EMS leaders, ED clinicians, and educators who want fewer unnecessary interventions, better outcomes, and cleaner QA/QI discussions.CE credit:This episode is accredited for continuing education, (link to CME system coming soon!)

Guest: Stephanie Lehmann, BSN, RN, NRPIn this episode, Dustin Weber is joined by seasoned emergency nurse and paramedic Stephanie Lehmann, whose more than 23 years of EMS and ER experience bring a wealth of practical wisdom to the mic. Together, they explore the art of identifying critically ill patients from across the room—without relying on monitors or machines.From subtle visual cues to hands-on assessments, Dustin and Stephanie break down how to trust your clinical instincts, sharpen your observational skills, and recognize when a patient is truly sick. This conversation is packed with pearls for EMS providers, nurses, and anyone working in high-acuity environments.Whether you're new to the field or a veteran provider, this episode will challenge you to look beyond the numbers and lean into the power of experience, intuition, and bedside presence.Link to CME coming soon!

In this episode of Back In Quarters, we’re joined byDr. Nick Wleklinski to unpack the world of prehospital protocols. We explore what protocols really are, how they’re developed, and why they matter on the front lines of EMS. Whether you’re a new EMT or a seasoned medic, thisconversation sheds light on the clinical reasoning, collaboration, and challenges behind the guidelines we follow in the field.

In this episode of Back In Quarters, Dustin sits down with Chief Joe Pulvermacher and Lt. Rob Kunze of the Fitchburg Fire Department to discuss their pioneering peer support program.  The guests discuss the purpose of peer support, and how their agency provides it.  We learn about FFD's road to create their program, and their advice to others on starting their own. DISCLAIMER: This podcast is provided as a public service.  Back in quarters should not be used a source of medical advice, medical direction, or legal advice or council.  Always follow your local protocols, medical direction, policies and procedures. Reference to any specific product or entity does not constitute an endorsement or recommendation. The views expressed by guests are their own and their appearance on the program does not imply an endorsement of them or any entity they represent. Views and opinions expressed by the hosts do not necessarily reflect the view of their respective employers or others. If you have any questions about this disclaimer, please contact us.

On the next episode of Back In Quarters, Dustin sits down with Chief Joe Pulvermacher and Lt. Rob Kunze of the Fitchburg Fire Department to discuss first responder mental health, well-being, and how to maintain it through a peer support program.