by Critical Levels
Hosted by paramedic Zach Cantor, "Critical Levels" is a new podcast dedicated to having critical conversations in paramedicine. "Critical Levels" is a podcast for paramedics, by paramedics, with a Canadian and local bias.</br> <br>Please visit our website - http://www.criticallevels.ca - for more information</br> <br>Please email us at info@criticallevels.ca for any suggestions/feedback/comments</br> <br> Follow us on Twitter: @criticalevels</br>
Language
🇺🇲
Publishing Since
1/3/2020
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April 3, 2026
<p data-start="2157" data-end="2464">Shift work is a core part of paramedicine, but growing evidence shows it carries real long-term health risks.</p> <p data-start="2157" data-end="2464">In this episode, with Dr. James Gilbertson, we explore the science behind circadian rhythm disruption, the impacts of sleep deprivation, and how lifestyle and longevity medicine can help mitigate risk.</p> <p data-start="2466" data-end="2489"><strong data-start="2466" data-end="2489">Key Topics Covered:</strong></p> <ul data-start="2490" data-end="2899"> <li data-section-id="9yqx3f" data-start="2490" data-end="2543">Why shift work affects lifespan and health outcomes</li> <li data-section-id="fs7dap" data-start="2544" data-end="2583"> Circadian rhythm disruption explained</li> <li data-section-id="1rvyy71" data-start="2584" data-end="2687"> Links between shift work and: <ul data-start="2618" data-end="2687"> <li data-section-id="32g63f" data-start="2618" data-end="2642"> Cardiovascular disease</li> <li data-section-id="1qp237" data-start="2645" data-end="2658"> Cancer risk</li> <li data-section-id="192tt97" data-start="2661" data-end="2687"> Mental health challenges</li> </ul> </li> <li data-section-id="2iwy4l" data-start="2688" data-end="2737"> Sleep optimization strategies for shift workers</li> <li data-section-id="v7oekb" data-start="2738" data-end="2771"> Exercise and longevity evidence</li> <li data-section-id="kiypyh" data-start="2772" data-end="2813"> Nutrition approaches that work on shift</li> <li data-section-id="fdz3jk" data-start="2814" data-end="2854"> Social connection and cognitive health</li> <li data-section-id="8fpzgg" data-start="2855" data-end="2899"> Practical, realistic habits for paramedics</li> </ul>
February 28, 2026
<p data-start="134" data-end="417">In this episode of Critical Levels, Zach sits down with <strong data-start="192" data-end="233"><span class= "whitespace-normal">Dr. Anna-Maria Carvalho</span></strong>, a Royal College–certified emergency physician with a subspecialty in aviation medicine, to unpack what really happens when someone asks, "Is there a medical professional on board?"</p> <p data-start="419" data-end="723">From the physiology of flying at 36,000 feet to the realities of managing cardiac arrest in a cramped aircraft cabin, this episode tackles the fears, logistics, and practical considerations of in-flight medical emergencies—especially for paramedics, nurses, and physicians who may be called upon to help.</p> <hr data-start="725" data-end="728" /> <h3 data-start="730" data-end="750">✈️ What We Cover</h3> <p data-start="752" data-end="783"><strong data-start="752" data-end="783">🫁 The Physiology of Flight</strong></p> <ul data-start="784" data-end="1121"> <li data-start="784" data-end="857"> <p data-start="786" data-end="857">Why cabin altitude means we're all mildly hypoxic (normal sats ~92–93%)</p> </li> <li data-start="858" data-end="930"> <p data-start="860" data-end="930">How hypoxia increases heart rate, blood pressure, and sympathetic tone</p> </li> <li data-start="931" data-end="967"> <p data-start="933" data-end="967">Why alcohol hits harder in the air</p> </li> <li data-start="968" data-end="1012"> <p data-start="970" data-end="1012">Why tomato juice tastes better at altitude</p> </li> <li data-start="1013" data-end="1057"> <p data-start="1015" data-end="1057">The risk of DVTs and who's most vulnerable</p> </li> <li data-start="1058" data-end="1121"> <p data-start="1060" data-end="1121">Barotrauma, ear pain, and when a perforated eardrum can occur</p> </li> </ul> <p data-start="1123" data-end="1159"><strong data-start="1123" data-end="1159">🚨 In-Flight Medical Emergencies</strong></p> <ul data-start="1160" data-end="1394"> <li data-start="1160" data-end="1190"> <p data-start="1162" data-end="1190">Incidence: ~1 in 600 flights</p> </li> <li data-start="1191" data-end="1288"> <p data-start="1193" data-end="1216">Most common categories:</p> <ul data-start="1219" data-end="1288"> <li data-start="1219" data-end="1233"> <p data-start="1221" data-end="1233">Neurologic</p> </li> <li data-start="1236" data-end="1247"> <p data-start="1238" data-end="1247">Cardiac</p> </li> <li data-start="1250" data-end="1265"> <p data-start="1252" data-end="1265">Respiratory</p> </li> <li data-start="1268" data-end="1288"> <p data-start="1270" data-end="1288">Gastrointestinal</p> </li> </ul> </li> <li data-start="1289" data-end="1335"> <p data-start="1291" data-end="1335">The realities of flying with chronic disease</p> </li> <li data-start="1336" data-end="1394"> <p data-start="1338" data-end="1394">Why more emergencies are happening as more people travel</p> </li> </ul> <p data-start="1396" data-end="1439"><strong data-start="1396" data-end="1439">🧰 What's in the Emergency Medical Kit?</strong></p> <ul data-start="1440" data-end="1847"> <li data-start="1440" data-end="1477"> <p data-start="1442" data-end="1477">AED (separate from the medical kit)</p> </li> <li data-start="1478" data-end="1497"> <p data-start="1480" data-end="1497">Oxygen & Ambu bag</p> </li> <li data-start="1498" data-end="1553"> <p data-start="1500" data-end="1553">Oral airways (intubation equipment varies by airline)</p> </li> <li data-start="1554" data-end="1626"> <p data-start="1556" data-end="1626">IV supplies (limited fluids, but enough for medication administration)</p> </li> <li data-start="1627" data-end="1739"> <p data-start="1629" data-end="1739">Medications: epinephrine, steroids, bronchodilators, benzodiazepines, antipsychotics, glucose agents, and more</p> </li> <li data-start="1740" data-end="1800"> <p data-start="1742" data-end="1800">BP cuff (palpated pressures only—too noisy to auscultate!)</p> </li> <li data-start="1801" data-end="1847"> <p data-start="1803" data-end="1847">Pulse oximeter (remember: 93% can be normal)</p> </li> </ul> <p data-start="1849" data-end="1884"><strong data-start="1849" data-end="1884">📡 Ground-Based Medical Support</strong></p> <ul data-start="1885" data-end="2153"> <li data-start="1885" data-end="1948"> <p data-start="1887" data-end="1948">Most airlines consult 24/7 emergency physicians on the ground</p> </li> <li data-start="1949" data-end="2009"> <p data-start="1951" data-end="2009">Volunteers don't make diversion decisions—the captain does</p> </li> <li data-start="2010" data-end="2082"> <p data-start="2012" data-end="2082">Diversions involve significant operational and logistical consequences</p> </li> <li data-start="2083" data-end="2153"> <p data-start="2085" data-end="2153">In-flight volunteers are there to assess, stabilize, and communicate</p> </li> </ul> <p data-start="2155" data-end="2191"><strong data-start="2155" data-end="2191">🫀 Cardiac Arrest at 36,000 Feet</strong></p> <ul data-start="2192" data-end="2394"> <li data-start="2192" data-end="2231"> <p data-start="2194" data-end="2231">Move to a bulkhead/galley if possible</p> </li> <li data-start="2232" data-end="2272"> <p data-start="2234" data-end="2272">Call for additional medical volunteers</p> </li> <li data-start="2273" data-end="2288"> <p data-start="2275" data-end="2288">Early AED use</p> </li> <li data-start="2289" data-end="2338"> <p data-start="2291" data-end="2338">CPR until ROSC, exhaustion, or medical futility</p> </li> <li data-start="2339" data-end="2394"> <p data-start="2341" data-end="2394">Diversion decisions are collaborative and situational</p> </li> </ul> <p data-start="2396" data-end="2421"><strong data-start="2396" data-end="2421">⚖️ The Legal Question</strong></p> <ul data-start="2422" data-end="2660"> <li data-start="2422" data-end="2456"> <p data-start="2424" data-end="2456">Good Samaritan protections apply</p> </li> <li data-start="2457" data-end="2475"> <p data-start="2459" data-end="2475">Act within scope</p> </li> <li data-start="2476" data-end="2519"> <p data-start="2478" data-end="2519">No gross negligence or willful misconduct</p> </li> <li data-start="2520" data-end="2610"> <p data-start="2522" data-end="2610">No one has ever been successfully sued for assisting with an in-flight medical emergency</p> </li> <li data-start="2611" data-end="2660"> <p data-start="2613" data-end="2660">You are not responsible for diversion decisions</p> </li> </ul> <p data-start="2662" data-end="2697"><strong data-start="2662" data-end="2697">🕊️ When Death Occurs In Flight</strong></p> <ul data-start="2698" data-end="2861"> <li data-start="2698" data-end="2749"> <p data-start="2700" data-end="2749">Resuscitation attempts may cease when appropriate</p> </li> <li data-start="2750" data-end="2778"> <p data-start="2752" data-end="2778">Diversion is not automatic</p> </li> <li data-start="2779" data-end="2861"> <p data-start="2781" data-end="2861">Flight crew are trained to manage these situations professionally and discreetly</p> </li> </ul> <hr data-start="2863" data-end="2866" /> <h3 data-start="2868" data-end="2888">🔑 Key Takeaways</h3> <ul data-start="2890" data-end="3253"> <li data-start="2890" data-end="2922"> <p data-start="2892" data-end="2922">You already have the skills.</p> </li> <li data-start="2923" data-end="2990"> <p data-start="2925" data-end="2990">The environment is different—but the fundamentals are the same.</p> </li> <li data-start="2991" data-end="3048"> <p data-start="2993" data-end="3048">Recognizing sick vs. not sick is incredibly valuable.</p> </li> <li data-start="3049" data-end="3125"> <p data-start="3051" data-end="3125">Most in-flight volunteer diagnoses are ultimately confirmed in hospital.</p> </li> <li data-start="3126" data-end="3187"> <p data-start="3128" data-end="3187">About 60% of passengers improve with basic stabilization.</p> </li> <li data-start="3188" data-end="3253"> <p data-start="3190" data-end="3253">You are protected when acting in good faith and within scope.</p> </li> </ul> <p data-start="3255" data-end="3351">If you've ever hesitated to answer that overhead call, this episode may change your perspective.</p>
January 29, 2026
<p>On this unique episode, we attend the First60 Toronto Resuscitation Conference and interview several of the speakers. For more detailed information, check out our website, criticallevels.ca</p>
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Dr Alan Batt
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Anthony Iacolucci
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Hosted by paramedic Zach Cantor, "Critical Levels" is a new podcast dedicated to having critical conversations in paramedicine. "Critical Levels" is a podcast for paramedics, by paramedics, with a Canadian and local bias.</br>
<br>Please visit our website - http://www.criticallevels.ca - for more information</br>
<br>Please email us at info@criticallevels.ca for any suggestions/feedback/comments</br>
<br> Follow us on Twitter: @criticalevels</br>
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