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
What do you do when the blood pressure monitor shows a number you don’t like? Most providers hit the button again—but what if it’s real? In this episode, we’re joined by critical care transport specialist James Boomhower from Boston MedFlight, recorded live at the FASTCAN conference in Calgary, to break down modern vasopressor management.
We explore how norepinephrine replaced dopamine as the first-line vasopressor, the evidence behind those changes, and what to do when your patient is on three drips and the pressure still won’t budge. James shares practical, real-world insights from the space between the ED and ICU, where seconds matter and protocols are stress-tested in real time.
Key takeaways include: when to trust your BP reading and act, how to choose and sequence pressors based on evidence and logistics, why norepinephrine reduces arrhythmias and improves outcomes, and when to add adjuncts like steroids, sodium bicarb, or methylene blue. We also explore hidden factors like ventilator settings and underlying causes that can sabotage even the best pharmacology.
Want to build unshakeable confidence on scene? We have developed a program to help paramedics go from self-doubt and imposter syndrome to calm competent providers others look to in crisis. If you want to learn more about our Paramedic Confidence Builder course reach out via email at [email protected] or through our contact page at emspodcast.com or via DM on IG @emsloudandclear
Guest/Cast/Crew information-
Guest- James Boomhower, LMHC-A, FP-C
Host- Ross Orpet
Catch up with us after the show
- Instagram- @emsloudandclear
- YouTube- https://www.youtube.com/@EMSLoudandClear
Website- www.emspodcast.com
