The Overrun

Summary This episode is a follow-up to our last episode about the 2025 AHA updates. Our guest is Remle Crowe, one of the authors of section 4 of the 2025 AHA updates, which specifically addresses systems of care. The conversation delves into the complexities of resuscitation practices in emergency medical services, highlighting the stark reality that many resuscitations do not yield favorable outcomes. It emphasizes the importance of evidence-based practices while also addressing the emotional burden placed on EMTs when delivering difficult news to families. The discussion encourages a holistic view of patient care that considers both clinical evidence and the human impact of medical decisions. Takeaways Many resuscitations do not have a favorable outcome.Best practices suggest resuscitating in place.EMTs face emotional challenges in delivering bad news.Training often glosses over difficult scenarios.Ignoring uncomfortable topics does not make them go away.Evidence-based practices can still lead to harm.Communication is key in challenging situations.The emotional toll on EMTs is significant.Real-life scenarios often differ from textbook cases.Holistic patient care must consider emotional impacts. Keywords resuscitation, EMT, best practices, emotional impact, patient outcomes, evidence-based medicine, termination on scene, communication, healthcare challenges, trauma care OverrunEMS.com

The 2025 AHA Guidelines have ignited a powerful, emotional conversation inside EMS and hospital systems. In this eye-opening episode, Ed Bauter, Dan Schwester, and Dr. Mike DeFilippo confront a controversial but crucial question:  Are we performing CPR on people we know will not benefit—and is that causing more suffering than saving? With new evidence, emerging ethical dilemmas, and shifting expectations around end-of-life care, this episode forces us to examine long-held assumptions and look at CPR through a more honest, patient-centered lens.  Link to the official AHA 2025 summary:https://cpr.heart.org/-/media/CPR-Files/2025-documents-for-cpr-heart-edits-posting/Resuscitation-Science/252500_Hghlghts_2025ECCGuidelines.pdf?sc_lang=en  Key Insights You Don’t Want to Miss CPR is not universally life-saving—and often causes devastating harm in the wrong populations. Ethical medicine requires avoiding meaningless interventions that prolong suffering. Patients with severe dementia, frailty, terminal illness, or irreversible decline see almost no benefit from CPR. Age, cognitive status, and functional baseline must influence our decisions. The culture of “CPR for everyone” is being replaced by evidence-driven, compassionate care. EMS providers must balance clinical realism with patient autonomy and dignity. The new AHA updates demand a dramatic shift in how clinicians communicate and act during cardiac arrest. If this conversation challenged your thinking, share it with a colleague.Then join us for: Monday Afternoon Journal Club on YouTube Leadership & clinical education at OverrunEMS.com Weekly EMS insights on TikTok, Instagram, and LinkedIn @OverrunEMS

Summary In this episode of the Overrun Podcast, hosts Ed Bauter and Dan Schwester engage with Josh Kimbrell and Judah Kreinbrook to discuss their recent research on cardiac arrest, focusing on the critical delays in defibrillation and chest compressions. The conversation explores the implications of these delays, the phenomenon of rearrest, and the importance of a tactical pause in emergency medical services (EMS) to optimize patient care. The discussion emphasizes the need for quality improvement in pre-hospital care and the potential for future research to enhance outcomes for patients experiencing cardiac arrest. Takeaways Delays in defibrillation and chest compressions are significant.A substantial percentage of patients may rearrest during transport.Tactical pauses can optimize patient care before moving them.Quality improvement in EMS is essential for better outcomes.Understanding the factors leading to rearrest is crucial.Monitoring and measuring patient responses during transport is vital.The research highlights the fragility of patients post-ROSC.Engaging with medical directors can lead to better protocols.The need for further research in pre-hospital cardiac arrest care is evident.Awareness of the risks associated with patient movement is critical. Sound bites “We have to admit there is a problem.”“We should consider a bundle of care here.”“We need to pay attention to our patients.” Keywords cardiac arrest, defibrillation, chest compressions, rearrest, EMS, patient care, emergency medicine, quality improvement, pre-hospital care, medical research Chapters 00:00 Introduction to the Study and Participants01:08 Exploring Post-Arrest Care and Delays04:14 Analyzing Rearrest Patterns and Defibrillation Delays11:37 Understanding Movement and Its Impact on Rearrest17:32 Practical Implications and Future Directions19:02 Understanding Physiological Instability in Patients19:57 The Importance of Tactical Pauses21:53 Exploring the Role of Technology in Patient Monitoring23:46 Optimizing Patient Care Post-ROSC25:32 Navigating ECMO Guidelines and Patient Transport Decisions28:10 The Need for Research in EMS Practices30:50 Quality Improvement in Emergency Medical Services34:26 Final Thoughts on Patient Monitoring and Care OverrunEMS.com Paper: https://pubmed.ncbi.nlm.nih.gov/40850145/

Summary In this episode of the Overrun Podcast, hosts Ed Bauter and Dan Schwester engage with Scott Weingart to discuss critical topics in emergency medical services (EMS). The conversation covers the importance of whole blood in prehospital care, the logistical challenges of blood supply, and strategies for overcoming resistance to change within EMS systems. They also delve into advancements in defibrillation techniques, the use of pressors, and the significance of addressing burnout among EMS professionals. The episode concludes with a discussion on the potential role of ultrasound in EMS, emphasizing the need for effective tools in critical care settings. Keywords EMS, whole blood, defibrillation, push dose pressors, burnout, ultrasound, blood supply, logistics, critical care, emergency medicine Takeaways Whole blood is essential for critically ill trauma patients in the field.Logistical challenges hinder the effective use of blood in EMS.Evidence-based practice is crucial for implementing changes in EMS.Dual sequential defibrillation shows promise in resuscitation efforts.Dopamine should be phased out in favor of norepinephrine.Push dose pressors should be used judiciously and not repeatedly.Burnout is a significant issue in EMS that needs addressing.Self-care and mental health are vital for EMS professionals.Compassionate care can help combat cynicism in the field.Ultrasound technology has potential benefits for EMS, especially in IV access. Sound bites “Whole blood is just the ideal product.”“Stop using dopamine in EMS.”“Ultrasound should be on the buses.” Chapters 00:00 Introduction to the Overrun Podcast03:03 The Importance of Whole Blood in EMS07:42 Logistical Challenges in Blood Supply08:35 Overcoming Resistance to Change in EMS12:13 Advancements in Defibrillation Techniques19:32 Pressors in EMS: What Works Best?25:33 The Role of Push Dose Pressors30:47 Addressing Burnout in EMS36:53 The Future of Ultrasound in EMS www.overrunems.com www.emcrit.org

Summary In this episode of the Overrun Podcast, Ed Bauter and Dan Schwester welcome Anthony Christian, known as Badge502, to discuss the impact of social media on EMS and medicine. They explore Badge502’s journey from EMT to social media influencer, the importance of humor and mental health in the EMS community, and the challenges of navigating social media policies. The conversation also touches on the balance between humor and professionalism, the significance of anonymization in social media posts, and the positive influence of social media on aspiring EMS professionals. Additionally, they address the issue of misinformation in the field and the phenomenon of shadow banning on social media platforms. Keywords social media, EMS, mental health, humor, influencer, education, policies, misinformation, shadow banning, community engagement Takeaways Social media has a significant impact on EMS and medicine.Humor can be a vital tool for mental health in high-stress environments.It’s essential to be mindful of social media policies in EMS.Anonymization is crucial when sharing content related to patient care.Social media can inspire new generations to pursue careers in EMS.Misinformation can spread easily on social media, requiring vigilance.Shadow banning can affect content visibility on social media platforms.Using social media for good can enhance community engagement.Balancing humor and professionalism is key in EMS content creation.It’s important to foster a supportive and positive online community. Chapters 00:00 Introduction to Social Media in EMS01:07 The Journey of Content Creation03:30 The Impact of Humor on Mental Health08:05 Navigating Social Media Policies11:33 The Balance of Humor and Professionalism16:07 Anonymization and Ethical Considerations20:07 The Importance of Education in Emergency Response22:59 The Role of Social Media in EMS Education25:00 The Impact of Content Creation on Future Generations26:39 Navigating Misinformation in the EMS Community30:36 The Challenges of Shadow Banning and Social Media Algorithms31:43 Agency Mandated Training and Its Necessity33:07 Respecting Patient Privacy in the Digital Age36:12 Understanding Shadow Banning in Social Media OverrunEMS.com

Summary In this episode of the Overrun Podcast, Dr. Andrew Fisher discusses the implications of using whole blood in emergency medical services (EMS), particularly in relation to trauma care and sepsis. The conversation explores the benefits and complications of whole blood transfusions, the financial challenges faced by EMS systems, and the importance of community engagement in supporting these programs. Dr. Fisher emphasizes the need for ongoing research and adaptation in EMS practices to improve patient outcomes, including the potential role of freeze-dried plasma as an alternative to whole blood. Keywords whole blood, EMS, sepsis, trauma care, hemorrhagic injury, freeze-dried plasma, blood transfusion, emergency medicine, patient outcomes, community engagement Takeaways Whole blood is a significant advancement in trauma care.There is a 4% increase in sepsis risk with each unit of whole blood.EMS should focus on treating immediate patient needs.Financial sustainability is a major concern for whole blood programs.Community support is essential for the success of EMS initiatives.Freeze-dried plasma may revolutionize pre-hospital care.EMS must take ownership of hemorrhagic control practices.Research should guide changes in EMS protocols.The cost of blood products can impact patient care decisions.Ongoing education and adaptation are crucial for EMS professionals. Titles The Future of Whole Blood in EMSSepsis Risks and Whole Blood: What You Need to Know Sound bites “We have to lobby for better EMS funding.”“Freeze-dried plasma could be a game changer.”“The evolution of EMS practices is ongoing.” Chapters 00:00 Introduction to Whole Blood in EMS02:52 Understanding Sepsis and Whole Blood Complications05:43 The Role of Whole Blood in Trauma Care08:28 Financial Implications of Whole Blood Use11:12 Alternatives to Whole Blood in Emergency Care13:37 Future of Hemorrhagic Trauma Treatment16:10 Community Engagement and Support for EMS19:01 Conclusion and Future Directions

Summary In this episode, Dr. Peter Antevy discusses the critical role of EMS in the early treatment of sepsis, challenging the traditional view that sepsis is solely a hospital issue. He emphasizes the importance of data-driven approaches, early intervention, and the need for EMS to adopt effective treatment protocols. The conversation highlights the potential for EMS to significantly impact patient outcomes and reduce hospital burdens by providing timely care in the field. In this conversation, Peter Antevy discusses the innovative treatment of sepsis using spray-dried plasma, emphasizing its potential to improve patient outcomes. The dialogue explores the importance of data collection in recognizing and treating sepsis, the challenges faced in implementing evidence-based practices in EMS, and the need for transparency in healthcare data. Antevy highlights the role of clinicians in bridging the gap between research and practice, advocating for progressive protocols in EMS, and the necessity of adapting to the evolving landscape of healthcare. Takeaways Sepsis is often misunderstood as a hospital-only issue.EMS can and should be involved in sepsis treatment.Data is crucial for demonstrating the effectiveness of EMS interventions.Early treatment of sepsis can drastically improve patient outcomes.Protocols for sepsis management in EMS are essential.The healthcare system needs to recognize the value of EMS.Fluid resuscitation and antibiotics are critical in the field.The role of EMS can alleviate pressure on emergency departments.Understanding the business side of healthcare is important for EMS.Future advancements in EMS will include more comprehensive treatment options. Spray-dried plasma could revolutionize sepsis treatment.Data collection is crucial for recognizing and treating sepsis.There is a gap between clinical practice and research.RCTs are essential for validating new treatments.High-performance CPR is a cost-effective improvement.EMS must adapt to changes in healthcare delivery.Data transparency can drive improvements in EMS.Innovative treatments require rigorous research and validation.Small agencies can implement progressive protocols without high costs.The future of EMS lies in proactive patient care beyond 911 calls. Chapters 00:00 Introduction to Sepsis and EMS03:11 The Role of EMS in Sepsis Treatment05:47 Data-Driven Approaches to Sepsis09:05 The Importance of Early Intervention12:00 Protocols and Practices in Sepsis Management14:54 The Future of EMS in Sepsis Care26:29 Innovations in Plasma Treatment for Sepsis28:08 The Importance of Data in Recognizing and Treating Sepsis30:21 Bridging Clinical Practice and Research33:20 The Future of EMS Research and Data Collection39:06 Challenges in Implementing Evidence-Based Practices43:18 Navigating Resources in EMS for Progressive Protocols46:55 The Need for Data Transparency in EMS

Summary In this episode of the Overrun Podcast, Ed Bauter speaks with Greg Clopp, a former paramedic turned nurse anesthetist, about the evolution and nuances of Rapid Sequence Intubation (RSI) in emergency medicine. They discuss the importance of understanding patient needs, the role of various medications, and the shift towards Delayed Sequence Intubation (DSI) as an alternative to RSI. The conversation also touches on the challenges faced by EMS professionals, the importance of patient assessment, and the potential for career growth within the industry. Greg shares insights on how to navigate the EMS landscape and the importance of having diverse options in medication protocols. Takeaways RSI is taken more seriously in modern practice.One size doesn’t fit all in patient care.Aggressive treatment is necessary in emergency settings.Career opportunities in EMS are limited on the East Coast.Understanding patient needs is crucial for effective treatment.Video laryngoscopy has its limitations, especially with cervical spine injuries.Push dose pressors can be beneficial in fragile patients.Diverse medication options are essential for effective care.Patient assessment should guide treatment decisions.Career pathways in EMS can lead to advanced practice roles. Chapters 00:00 Introduction to RSI and Its Evolution03:09 The Nuances of RSI in Practice05:59 Exploring Alternatives: DSI vs. RSI09:01 The Role of Medications in RSI11:56 The Disconnect Between Field and Hospital Practices14:59 Video Laryngoscopy: Benefits and Risks18:10 Career Pathways in EMS and Nursing20:58 Final Thoughts on EMS and Career Growth

Summary In this episode of the Overrun Podcast, Ed and Dan welcome intensivist Eddie Joe Gutierrez to discuss the use of vasopressors in emergency medical services (EMS). The conversation covers the challenges of peripheral IV access, the importance of early vasopressor administration in hypotensive patients, and the evolving understanding of fluid resuscitation in sepsis. Eddie emphasizes the significance of norepinephrine as a first-line vasopressor and compares it to phenylephrine, while also addressing the complexities of managing cardiogenic shock in the pre-hospital setting. In this conversation, Eddy Joe Gutierrez discusses critical aspects of managing shock and trauma in pre-hospital settings. He emphasizes the importance of understanding different types of shock, the role of vasopressors, and the challenges pre-hospital teams face. The discussion also covers the use of whole blood in trauma care and the growing interest in point-of-care ultrasound. Ultimately, the key takeaway is the urgency of restoring perfusion to patients as quickly as possible, with norepinephrine being the preferred vasopressor in many situations. Takeaways Peripheral vasopressors are essential in pre-hospital settings. Doing nothing in critical situations is not an option. Fluid resuscitation has its limits; vasopressors may be necessary. Norepinephrine is preferred due to its dual action on alpha and beta receptors. Early administration of vasopressors can lead to better outcomes. The traditional approach of flooding patients with fluids is being reconsidered. Understanding hemodynamics is crucial for effective treatment. Phenylephrine may not be suitable for all patients due to its effects on cardiac output. Patient history is often limited in pre-hospital care, complicating treatment decisions. The focus should be on stabilizing the patient, regardless of the specific vasopressor used. Understanding the nuances of shock is crucial for effective management. Norepinephrine is often the first choice for vasopressor therapy. Whole blood administration can be beneficial in trauma cases. Point-of-care ultrasound is gaining traction but requires training. Pre-hospital teams face unique challenges without advanced tools. Restoring perfusion is the primary goal in critical care. The choice of vasopressor should be based on the patient’s condition. Effective communication between pre-hospital and hospital teams is essential. Training in ultrasound and other skills is evolving in medical education. The focus should always be on patient outcomes and safety. Chapters 00:00 Introduction to Vasopressors in EMS02:49 Peripheral IV Access and Vasopressors05:54 Early Use of Vasopressors in Hypotensive Patients09:04 Fluid Resuscitation vs. Vasopressors in Sepsis12:00 Understanding Norepinephrine and Its Mechanism14:58 Comparing Vasopressors: Norepinephrine vs. Phenylephrine17:57 Cardiogenic Shock and Its Management20:21 Understanding Shock: A Clinical Perspective24:07 Trauma Management and Whole Blood Administration26:56 Point-of-Care Ultrasound in Pre-Hospital Settings29:13 Vasopressors: Choosing the Right Agent36:52 Restoring Perfusion: The Key Takeaway Eddy Joe’s work can be found on Instagram @eddyjoemd Buy his book here

Summary In this episode of the Overrun Podcast, Ed Bauter and Dan Schwester engage with immigration attorney Matthew Hartnett to discuss the complex interactions between EMS professionals and ICE agents. The conversation delves into the rights of EMS workers and patients, the legal boundaries of ICE’s jurisdiction, and the importance of maintaining patient privacy under HIPAA during emergencies. Hartnett emphasizes the need for EMS workers to understand their rights and responsibilities when encountering ICE, especially in sensitive environments where medical care is provided. The discussion highlights the evolving landscape of immigration enforcement and its implications for public safety and patient care. Takeaways EMS workers have specific rights when interacting with ICE agents.The right to privacy under the Fourth Amendment is crucial for patients.ICE cannot enter a home without a judicial warrant.Public spaces have different privacy expectations compared to private spaces.Emergency medical situations require a delicate balance of rights and responsibilities.HIPAA regulations must be upheld even in the presence of ICE.Communication with ICE should focus on patient care and privacy.Understanding the legal framework surrounding ICE is essential for EMS professionals.The landscape of immigration enforcement is changing and may impact EMS operations.Maintaining patient confidentiality is paramount in all interactions. Chapters 00:00 Understanding the Intersection of EMS and ICE18:02 Navigating Rights and Responsibilities in Emergency Situations