Critical Levels

Neonates - Anthony Iacolucci

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 – Electr...

Data-Driven Resuscitation & Seamless Transitions

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, includi...

K9 Medicine - Dr. Jason Donohoe

🔹 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 Anatom...

Frostbite - Dr. Maria Doubova

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 a...

TXA - Dr Erik Vu

Welcome to the first episode of 2025! This month, we’re diving into the critical role of Tranexamic Acid (TXA) in pre-hospital trauma care. Dr. Erik Vu, a critical care flight paramedic, emergency physician, and intensivist, joins us to discuss the latest insights and applications of TXA, particularly in dynamic and tactical environments. From its role in stabilizing clots to its use in mass casualty scenarios, we break down everything you need to know about this cost-effective and life-saving m...

Prehospital Blood - Dr. Antevy

On this month’s episode, we are going to talk about prehospital blood administration with Dr. Peter Antevy Some topics covered are: Historical trauma management Blood why blood components administration ratios blood type Blood administration who do we give blood to medical vs trauma (blunt vs penetrating) elderly vs peds vital sign parameters when do we administer it how do we give it IO vs IV (size matters…) temperature Logistics how do we get it patient side cold chain storage temperature mana...

Trauma-Informed Care for Children Youth - Marita Smith

How prepared do you feel to care for children and youth who have experienced abuse or assault? 1 in 10 Canadians (7.8%) over 15 report at least one instance of sexual abuse before age 15 ( Stats Canada ) Up to 88% of people being trafficked access health care ( Polaris Project ) - many don’t disclose they are being trafficked Highest rates of intimate partner violence occur between age 12-24 ( Stats Canada ) Young people aged 15-24 years have the highest rate of sexual assault ( Gov’t of Canada ...

CANSOFCOM - Steve & Andrew

On this month’s episode, we dive deep into the world of military medicine with special forces paramedics, pulling back the veil of secrecy surrounding their vital work. Join us as we explore the unique challenges and high-stakes scenarios these elite medics faced on the front lines. From advanced trauma care in combat zones to the mental resilience required for their demanding roles, our guests share their incredible experiences and insights. What is CANSOFCOM/JTF 2? What is your role within the...

Paramedic Violence - Dr Justin Mausz

On this month’s episode, we’re joined by Dr. Justin Mausz to discuss violence against paramedics. During the episode, you’ll hear us cover: How often are we seeing violence against paramedics What is violence? Is it different from harassment? Does intent matter? Incident reporting How does it compare to other industries? What does violence against paramedics look like? How do we balance paramedic and patient safety? What do we do with this? PPE Policy development External vs internal violence Th...

Heat Emergencies - Dr Steve Sanders

On this month’s episode, we’re joined by Dr. Steven Sanders to discuss heat related illnesses. During the episode, you’ll hear us cover: Health impacts of temperature increase Physics/physiology of temperature vs heat Spectrum of heat related illness heat rash heat cramps heat edema heat syncope heat exhaustion heat stroke exertional vs classic Comorbidities/confounders/risk factors Temperature assessment Disease management & treatment...

BVM - Dr. Bonnie Snyder

On this month’s episode, we’re joined by Dr. Bonnie Snyder to discuss BVM as well her recently published paper in Resuscitation: Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. During the episode, you’ll hear us cover: There is nothing basic about the BVM - it is not a benign intervention Rate and volume based on the guidelines Consequences of excessive rate/volume Consequences of under ventilation General airway management po...

TBI - Dr. Katie Lin

On this month’s episode, we’re joined by Dr. Katie Lin to discuss TBI and the crashing brain. During the episode, you’ll hear us cover: head injury differentials and history gathering ischemic vs hemorrhagic head injury etiology head injury pathophysiology assessment 3 step neuro exam pupil assessments signs/symptoms of herniation ECG changes management avoid/manage the H bombs (hypoxia, hypotension, hyperventilation) airway management ICP management other medications seizure management paediatr...

Pediatric Cardiac Arrest - Dr. Janice Tijssen

On this month’s episode, we’re joined by Dr. Janice Tijssen to discuss pediatric cardiac arrest. During the episode, you’ll hear us cover: The importance of our early interventions What is cardiac arrest incidence/epidemiology etiology risk factors/past medical history outcomes sociodemographics Differences between adult and pediatric cardiac arrest Simplifying our response Symptomatic bradycardia The importance of scene time The importance of CPR/ventilation IV vs IO, SGA vs ETT Epinephrine PRI...

Suboxone - Dr Louisa Marion-Bellemare

On this month’s episode, we’re joined by Dr. Louisa Marion-Bellemare to discuss Suboxone (buprenorphine/naloxone) and managing patients who use illicit and controlled drugs. During the episode, you’ll hear us cover: history of the drug crisis lay of the land of the current drug crisis historical treatments opiate pharmacology healthcare utilization stigma suboxone use patient advocacy

Wilderness Medicine - Matt Smith

On this month's episode, we chat with Matt Smith about wilderness medicine. As we shift from a high resource to a low resource setting, there are 3 main concepts to consider: - Ideal to real - High risk to low risk - Stable to unstable These concepts are important as we shift our practice and prepare ourselves. For this patient context, we need to focus on the things we can't replace, and learn to manage that. Our approach to these patients need to be algorithmic, and focus on doing the basics w...

Episode 35 - ACS - Dr. Jesse McLaren

On this month’s episode, we discuss acute coronary syndrome (ACS) with Dr. Jess McLaren We define ACS, we cover pathophysiology, and some common causes. Importantly we discuss the assessment of this patient population - paying attending to both objective and subjectives signs and symptoms. We spend some time talking about electrocardiograms, and perhaps most importantly, we chat about the management of this patient.

Anaphylaxis - Drs. Hendin & Lanoue

A Dive Into Drowning - Dr. James Gilbertson

On this episode, we’re joined by Dr. James Gilbertson with the Ottawa Hospital, and Cst. Caroline Gallant with The Ottawa Police Marine, Dive and Trails (MDT) Unit. We take a dive into drowning and cover: What drowning is The scale of the problem Drowning pathophysiology The medical management of drowning patients Prognostication Lastly, we speak to drowning prevention

Substance Use and the Paramedic Role - Jen Bolster

In British Columbia 7 people per day are dying as a result of a highly contaminated toxic supply of drugs. Since the announcement of the public health crisis related to illicit drug toxicity deaths in 2016 over 12,000 people have lost their lives. Despite previous misconceptions that the toxic drug crisis is confined to Vancouver’s lower mainland and the downtown east side, Jen is sounding the alarm that not a square inch of the province of BC has been unaffected by the crisis. Working on the fr...

No Statistical Difference - Dr. Ken Milne

“No statistical difference” On today’s episode of Critical Levels, we chat with Dr. Ken Milne of the Skeptics’ Guide to Emergency Medicine ( https://thesgem.com ; @thesgem). We start with a high-level discussion and literature and evidence, and then apply these concepts to ‘lyse’ and ‘bust’ some of the predominate prehospital myths. Find links to the primary literature on our website. We examine: 2:00 - The importance of primary literature 4:10 - Why? 10:10 – Literature, critically appraising ar...

Preparing Paramedics: Palliative Care - Cheryl Cameron Tyne Lunn

Paramedics receive little education on grief and bereavement. As paramedicine integrates palliative approaches to care, it has become very apparent paramedics are under-prepared for the crucial role they play in supporting patients and families in grief and recognizing and responding to their own grief reactions. In this episode we talk to Cheryl Cameron and Tyne Lunn about how paramedicine is evolving to include the provision of palliative care. We start by defining palliative care and talk abo...

Episode 29 - High Performance Cardiac Arrest Management - Adam Perrett and Mike Humphrey

On today’s episode, we carry on last month’s conversation about cardiac arrest management and care. Recorded at the Paramedicine Across Canada Expo (PACE) Conference in Saskatoon in September 2022, we’re sitting down with Mike Humphrey and Adam Perrett of Lethbridge Fire and Emergency Services to talk about how they’ve revolutionized the care provided to the citizens of Lethbridge, Alberta. We walk through how they train, evaluate, and feedback data with respect to cardiac arrests; how they use ...

DOSE VF with Dr. Sheldon Cheskes

On today's episode, we chat with Dr. Sheldon Cheskes, principal investigator of the landmark DOSE VF trial. In this study, published in the New England Journal of Medicine, Dr. Cheskes and his team wanted to evaluate DSED and VC defibrillation as compared with standard defibrillation in patients who remain in refractory ventricular fibrillation during out-of-hospital cardiac arrest. In this episode, we walk through the study design, methodology, results, and perhaps most importantly, critically ...

Episode 27 - Pediatric Pain with Dr. Samina Ali

Pain is a condition that we often see in the prehospital world, yet for a variety of reasons, we're bad at treating it. On today's episode with pain expert Dr. Samina Ali, we go through what pain is, pain assessment, barriers to providing analgesia, and then discuss how we actually treat pain, using both non-pharmacologic and pharmacologic interventions

First Responder Mental Health with Dr. Simon Hatcher

Join us this month as we chat with Dr. Simon Hatcher, psychiatrist at the Ottawa Hospital and Ottawa Inner City Health, about First Responder Mental Health Who gets PTSD, what’s the pathway/differences to mental health professionals, how do we heal, and how do we get people back to work are all topics we cover, plus more!

IveGotYourBack911

IVEGOTYOURBACK911 was started by paramedics Jill Foster & Shaun Taylor in 2014. The goal of the campaign is to spread social awareness worldwide in regards to First Responder mental health issues. On this month’s episode of Critical Levels, we sit down with Jill & Shaun to learn a little bit more about how and why they started the company, and some of the amazing work that they’re doing to help first responders.

Prehospital Trauma Care with Dr. Brodie Nolan

On today’s episode, we chat with Dr. Brodie Nolan, an emergency physician and trauma team leader at St. Michael's Hospital (one of Canada’s largest trauma centres), and a transport medicine physician for ORNGE. We discuss what trauma is, and how we define hemorrhagic shock. We discuss that trauma triad of death, and why it’s important to get these patients to a lead trauma centre. These patients ultimately need blood products, so Dr. Nolan walks us through blood/fluid resuscitation, as well as t...

PICU & Organ Donation with Dr. Sonny Dhanani

On today’s episode we sit down with Dr. Sonny Dhanani, Chief of the Pediatric Intensive Care Unit (PICU) at the Children’s Hospital of Eastern Ontario (CHEO). We discuss the approach and management of the critically ill child, with an in-depth discussion on the A-B-Cs. With respect to airway, we chat tips/tricks for airway management, as well as intubation. On the topic of breathing, we chat about bagging and some of the physiological cardio-respiratory concerns of our efforts. We also discuss t...

Human Trafficking - Dr. Lindsay Cheskes

The United Nations (UN) defines human trafficking (HT) as “the recruitment, transport, transfer, harbouring, or receipt of a person by such means as threat or use of force or other forms of coercion, abduction, fraud, or deception for the purpose of exploitation“. What is human trafficking? How prevalent is it? What are the red flags? How can I use the history and assessment to raise my index of suspicion? How do I advocate for my patient? Join our conversation with Dr. Lindsay Cheskes, EM Resid...

Canadian Medical Emergency Response Team with Lt. Col. Leilani Doyle MD

After the War in Afghanistan, the Chief of Defence Staff of the Canadian Armed Forces decided to create a brand new forward aeromedical evacuation capability. This is where our episode’s guest comes in. We speak with Dr. Leilani Doyle, Lt. Col. with the Canadian Armed Forces about her role in the creation of CMERT - the Canadian Medical Emergency Response Team. Not only are we going to cover the development, roles, training, and capabilities of the team, we’re also going to discuss how to optimi...