Learn what they didn't teach you in paramedic school
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About Us

Ross Orpet, MD
A board certified emergency medicine physician practicing in Colorado, I completed my residency at Denver Health Medical Center, as well as a fellowship in Emergency Medical Services. I got my start in emergency medicine working as a paramedic at the Denver Health Paramedic Division..
Will Berry, FP-C, NR-P
I have worked in EMS for 13 years and caught the bug to be involved in emergency response after working as a wilderness guide in Colorado. Most of my career was with the Denver Health Paramedic Division where I spent several years as a Lieutenant. I am currently a practicing critical care paramedic in North Carolina.

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Paramedic training is over, you’re in the front seat now. Whether day 1 or day 1,000 you can’t shake the fear you’re underprepared. You were taught to systematically decide if A… do B. But what if “A” wasn’t in the book? The truth is each emergency call is too unique to teach the right response to every situation. We need to go beyond algorithmic thinking and understand deeper principles, the WHY behind the algorithm. When every decision counts you want to rely on a framework that will guide you when things don’t make sense. Loud & Clear: EMS Guiding Principles is your resource to build that framework. Through discussions with experts, review of evidence-based best practices, and real-world case studies we teach you one step past what you learned in paramedic school. But all of this advanced education is connected back to the guiding principles that answer the question- “at the end of the day, what actually matters to the patient I have in front of me?” Our mission is to elevate your practice and help you improve patient outcomes in every emergency situation. You may not feel ready, you may not feel like you know enough, but by understanding the guiding principles of emergency medicine you can become an expert EMS clinician. Because what you do matters.
Loud & Clear: EMS Guiding Principles is an EMS Cast LLC production
These challenging scenarios represent opportunities to provide truly patient-centered care at life’s most vulnerable moments. By combining your medical expertise with thoughtful communication, you can help ensure patients’ wishes are honored while supporting families through difficult transitions. In this episode we dive into the complex ethical and legal dilemmas faced by EMS providers when arriving on scenes involving Do Not Resuscitate (DNR) and goals of care forms. With special guest Dr. Daniel Markwalter, an emergency physician and hospice/palliative care expert, the discussion touches on understanding the importance of these forms, the challenges of making decisions without clear directives, and strategies for effective communication with family members when they suddenly disagree with the form. This episode provides valuable insights and practical advice for EMS professionals who can be faced with these sometimes challenging scenarios.
00:00 Introduction: The Ethical Dilemma in EMS
00:49 Sponsor Message: The Recess Tailor
01:53 Case Study: Evening Shift Dilemma
03:33 Expert Insights: Dr. Daniel Mark Walter
04:40 Understanding Hospice and DNR
09:48 Advanced Directives and Code Status
19:20 Challenges with Comfort Care and Advanced Directives
26:19 Aligning Medical Knowledge with Patient Goals
28:34 Understanding Goals of Care
29:03 Respecting Autonomy in Medical Decisions
30:02 Effective Communication with Families
31:45 Navigating Family Overrides in Critical Moments
32:36 Legal Aspects of Surrogate Decision Making
36:00 Exploring Illness Understanding and Prognosis
45:46 Symptom Management in Palliative Care
49:43 Final Thoughts and Summary
Resources
- Get 10% off FAST25 with promo code- loud&clear
- The Resus Tailor
- Todays Episode Show Notes
- Survey- Help us learn what content you want
Gear We Like
- Good Stethoscope – https://amzn.to/3YJJrf2
- Good Shears – https://amzn.to/40FROuF or https://amzn.to/3ChZ4Tn
- Notepad for taking notes on calls – https://amzn.to/3Z1X21J
- Sunglasses – https://frontline-optics.com/discount/EMSCAST15
- Books we recommend –
- The Dichotomy of Leadership – https://amzn.to/4fiCAjN
- Extreme Ownership – https://amzn.to/3O1FWfa
- Managing the Unexpected: Sustained Performance in a Complex World – https://amzn.to/3V7BwYf
- Thinking Fast and Slow – https://amzn.to/4fiJG85
- A Thousand Naked Strangers: A Paramedic’s Wild Ride to the Edge and Back – https://amzn.to/3YJJrf2
Guest/Cast/Crew information-
Guest- Daniel Markwalter, MD
Host- Ross Orpet, Will Berry
Catch up with us after the show
- Instagram- @emsloudandclear
- YouTube- https://www.youtube.com/@EMSLoudandClear
- Website- www.emspodcast.com
