The Heavy Lies the Helmet® Podcast is by critical care professionals, for critical care professionals. Hosted by Mike Boone, Dan Rauh, and Dr. Amanda Humphries, we dive deep into the realities of emergency and critical care medicine.
Our conversations are raw, honest, and practical — cutting through the noise to focus on real-world challenges, clinical decision-making, and the human side of high-acuity care. Whether we’re unpacking complex patient scenarios, discussing the nuances of teamwork and leadership, or highlighting the mental and emotional weight of the job, our podcast offers a space where providers can learn, connect, and feel understood.
No fluff. No corporate agendas. Just real talk for real clinicians.
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What happens when resources are limited, transport is delayed, or you’re forced to manage a critically ill patient far beyond the typical flight window? In this podcast episode, Dr. Tim Hurtado and Brett Weiner help us dive into the challenges and realities of prolonged field care in air medical transport. We’ll explore clinical considerations, crew dynamics, and decision-making strategies that can help you maintain high-quality care when time isn’t on your side. We’re also excited to announce o...
Tranexamic Acid (TXA) is a lot like hot sauce: People put it on everything — especially for apparent or suspected acute blood loss. In this podcast episode, we dive into a drug that’s been both praised and questioned in trauma and prehospital care. We break down what TXA is, how it works, and the evidence behind its use. From CRASH-2 to CRASH-3, we explore the key studies, the controversies, and the real-world implications. Whether you’re administering TXA in the back of a rig or evaluating its ...
Though evidence dictates much of what we do as emergency medical providers, some areas remain open to debate: How are we justifying stroke ambulances, CCT speciality teams, AHA guidelines, and our choice of crystalloids? How are we justifying what professionals are allowed to post on social media? And do we agree with the currently accepted norms? Who better to join us in this discussion than Mike Carunchio of The World's Okayest Medic Podcast . Diving into these and other controversial topics, ...
Wet or dry. Air in or out. Reactive or obstructive. The possibilities may seem endless when treating the pediatric patient with undifferentiated respiratory distress. It is confounded by the fact that pediatrics are outside the comfort zone of many novice critical care transport providers. In this podcast episode, neonatal/pediatric specialist Nate Brown eases your worries with concise and effective means of diagnostics and intervention. Primarily, we cover croup, bronchiolitis, and asthma disea...
'Tis the season for trauma. (If there truly is a season.) Chest trauma, specifically, can vary in subtlety and severity, primarily due to the presence of multiple vital organs and vessels. In this podcast, we discuss these potentials while focusing on those injuries that are associated with the highest mortality rate. We also discuss why you should think twice before intervening. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Faceb...
Does your patient have high blood pressure? Are they seizing or showing other signs of a neurological disorder? It could be PRES! Unfortunately, Posterior Reversible Encephalopathy Syndrome (PRES) is difficult to diagnose unless you are aware of its existence. In this podcast episode, we discuss this infrequent condition and how can you appropriately diagnose and treat it. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ h...
Do certifications accurately reflect an individual's qualifications? This is an ongoing argument depending on what side of the exam you are on. How much value should we on that piece of paper? And, regardless, how do we work towards obtaining and maintaining qualifications? In this podcast episode, we discuss it all including Dunning-Kruger Effect and Hierachy of Competence. We also delve into teaching strategies that can help newcomers gain their confidence after achieving whatever got them the...
Previously, we recorded a podcast episode about the utility surrounding Point of Care Ultrasound (POCUS). In this episode, we apply that knowledge to specific case scenarios as a continuation of our "Breaking the Case" series. We also ask the question, is POCUS really all it's cracked up to be, or should we be re-thinking our approach, particularly in the prehospital setting? Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook ...
Humans are easy. That's why we are able to do what we do as prehospital providers. But what happens when your patient is a canine? These working dogs are highly regarded by their handlers and require care just like anyone else that may be ill or injured. Considering that, are you equipped to care for them? If not, how can you successfully start and maintain a K9 program at your agency? Tune in to another podcast to discuss this unique topic, but this time, we are joined by HLTH team member Rick ...
It can be difficult to determine whether you should treat undifferentiated hypertension or not. Many clinicians are distracted the number rather than focusing on the patient in front of them. Asymptomatic hypertension, in particular, is often benign. In fact, treating asymptomatic hypertension in a patient who a primary medical history of hypertension can harm them. In this podcast, we discuss these adverse effects related to blood pressure physiology, acute versus chronic hypertension, and how ...
The principles of preoxygenation and passive oxygenation should be familiar to any experienced intubator. Best practice recommends the use of a nasal cannula in conjunction with either a non-rebreather mask or bag-valve mask (BVM) to prevent hypoxemia during the apneic phase of Rapid Sequence Intubation (RSI). In the PREOXI Trial, the authors pushed this concept further, questioning whether non-invasive positive pressure ventilation (NIPPV) might be more effective than these formally mentioned a...
Not all cardiac arrests are created equal. Whether the presenting rhythm is asystole, ventricular fibrillation, or PEA, these patients require tailored interventions beyond "blanket" protocol and ACLS/PALS algorithms. When refractory to conventional therapy, the pulseless V-Tach/V-Fib patient, in particular, requires critical thinking "outside the box" in order to gain ROSC (Return of Spontaneous Circulation) and preserve neurological outcomes. What are some of the measures we can consider when ...
Interfacility transfers are not always indicated at the time and place of which they are being requested. Whether it's referring provider misinformation or a lack of advocacy by the transport agency, these transfers can result in unnecessary risk for crew members and patients. Specifically, weather conditions, time of day, crew fatigue, and other important factors are not always considered when blindly accepting these transfers. As the transport specialists, how can we ensure that we are accepti...
Antidiuretic hormone (ADH) plays an essential part in the body's osmotic/fluid balance, sodium homeostasis, and blood pressure regulation. This hormone is synthesized in the hypothalamus and released from the posterior pituitary gland. In conditions such as Diabetes Insipidus (DI) and Syndrome of Inappropriate ADH (SIADH), there is a lack of synthesis or over-production of this hormone which results in negative downstream effects. At the request of a podcast listener, we have decided to cover th...
Angioedema is defined by upper airway swelling secondary to an immune response. The trigger and subsequent physiological response are how we categorize it. In this podcast, we discuss how to diagnose and treat both types: IgE/Histamine-mediated and Bradykinin-mediated. We also touch on how to address the difficult airway that may or may not lead to intubation. All in all, do not fear angioedema but respect it. Get CE hours for our podcast episodes HERE ! -----------------------------------------...
When discussing methylene blue, management and treatment of methaemoglobinaemia is usually the first indication mentioned. But in this podcast, we challenge you to increase the size of your lense and focus on its benefits in other states (e.g., septic shock). Of course, we could not do this alone, so we invited a Flight Paramedic, Pharmacist, Toxicologist, and Professor to join us. And fortunately for us, they are all the same person. Tune in as Will Heuser helps us discuss the pathophysiology o...
Though we have delved into foreign HEMS systems in the past (See Episode 61 – Down Under Dynamics w/Dr. Cliff Reid ), we have not dedicated an entire series to it. Having now rubbed shoulders with many clinicians and operators around the world, it is evident that these conversations need to take place on a regular basis. Why? Because operating in a vacuum can lead to bad decision making. Our new "Around the World" series attempts to mitigate this by interviewing prehospital and intrahospital dis...
"Self-loading baggage" is a derogatory term often used by pilots to describe lazy or disengaged medical crew members in the air medical industry. Whether intentional or not, this behavior sets a bad precedent for those of us that want to embrace aviation cross-training and be able to assist the pilot effectively. In this podcast episode, we are joined by pilots Miles Dunagan and Brett Reeder to discuss how pilots and clinicians alike can be a cohesive team before, during, and after the flight. W...
The Russo-Ukrainian War is an ongoing international conflict between Russia and Ukraine. At times such as these, medical training is essential and sometimes required of laypersons. International Medical Corps partnered with the Harvard Humanitarian Initiative (HHI) to provide comprehensive emergency and trauma care training to healthcare workers, public safety professionals, and the Ukrainian community. Course Coordinator Kevin Collopy and Instructor Brock Jenkins, live from AMTC23, join us for ...
B.R.A.S.H. Syndrome is a phenomenon with a constellation of Bradycardia, Renal failure, AV nodal blockade, Shock, and Hyperkalemia requiring identification and management in the prehospital and transport setting. In this podcast episode, live from AMTC23, we discuss the pathophysiology of BRASH Syndrome, highlighting the synergy between its components, as well as relevant pharmacotherapy and treatment considerations. Get CE hours for our podcast episodes HERE ! ----------------------------------...
Dan presented the talk “Metabolic Acidosis: The Eye Can Only See What the Mind Can Comprehend” at AMTC23. In this recording, he teaches you how to identify the prevalence of acid-base disorders including triple disturbances, how to calculate anion gap and determine the etiology of the gap, and how to identify adequacy of compensation for a primary metabolic acidosis. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Facebook @ heavyli...
As a critical care clinician, do you consider yourself well-versed in comfort care? Do you consider yourself well-rehearsed in having the discussions leading up to the patient's or family's decision to implement it? This concept may be outside your comfort zone, especially if you work in emergency medicine. But the fact of the matter is, from the prehospital environment all the way to the ICU, we are provided many opportunities for implementation of this type of care plan. Join us for a discussi...
Atrial fibrillation, particularly A-Fib with RVR (Rapid Ventricular Response), is often an emergency requiring emergent intervention beyond ACLS and its associated algorithms. Identification of A-Fib can be challenging in itself, much less trying to determine what intervention(s) are indicated. This includes chemical and/or electrical cardioversion. So where do we start? And where should we end up? Dan and Mike will let you know in this podcast episode. Get CE hours for our podcast episodes HERE...
Continuing our "10 Things" series, we focus our attention on gastroenterology. GE/GI goes well beyond colorectal. From bleeding esophageal varices to pancreatitis to liver failure, these patients require specific diagnostics and interventions to improve their mortality and morbidity. Join us for a "pearl packed" episode where we discuss practical steps you can take to improve your care of this specialized patient population. Get CE hours for our podcast episodes HERE ! --------------------------...
Pediatric Emergency Medicine (PEM) is a sub-speciality that many clinicians find intimidating. Are pediatric patients truly unique or are they simply "little adults"? In this podcast episode, we are joined by Dr. Dominique Diggs, board certified PEM physician, to demystify pediatric emergency care with 10 tips that will help you the next time you care for this patient population. Get CE hours for our podcast episodes HERE ! -------------------------------------------- Twitter @ heavyhelmet Faceb...
Vascular emergencies refer to any time-sensitive condition where perfusion is prevented secondary to bleeding or occlusion of a vessel. These can include, but is not limited to, the superior mesenteric artery (SMA) and aorta. And depending on the severity of the aneurysm or embolism/thrombus, downstream ischemia can significantly impact a patient's quality of life. How do we identify these conditions? When are they classified as a true emergency? And how do we treat patients with the notion that...
Reviewing case studies with trusted colleagues can be extremely beneficial. Not only does it provide a moment of reflection on actions taken, but it also provides different approaches that may be applicable to future scenarios. Occasionally we like to challenge each other, and this episode is no exception. Tune in as Amanda, Dan, and Mike present three real case studies and see if they would approach the same patient differently. We start from "bread and butter" to the complex critically ill. Ge...
Have you ever handed off to an ER doctor, and you felt they were displeased with your care? Have you ever received an order from an ER doctor, and you didn't quite understand why? In this podcast episode, we continue our "10 Things" series with a focus on the emergency department. Our very own Dr. Amanda Humphries, Emergency Physician and Assistant Professor of Emergency Medicine and Emergency Medical Services, leads the discussion. Get CE hours for our podcast episodes HERE ! ------------------...
Myocardial infarctions can present in a variety of ways depending on vessel involvement, timing of pathology, and interpretation of diagnostics (e.g., 12-lead EKG). Unfortunately, not every patient with a myocardial infarction will fit STEMI criteria's paradigm, which has lead to the adoption of a new term: OMI (Occlusion Myocardial Infarction). In this podcast episode, we are joined by our very own Nick Zuber to discuss his recent OMI and why he's able to sit down and talk with us today. Get CE...
This episode emphasizes the often-overlooked challenges and high stakes of post-cardiac arrest management, focusing on an algorithmic approach to prevent re-arrest and optimize patient outcomes. The discussion covers appropriate vasopressor and oxygen management, the evolving evidence around targeted temperature management, safe sedation practices, and specialized considerations for traumatic arrest. The hosts advocate for a proactive, systematic approach to ensure patients not only survive but also regain a quality lifestyle.
