Acclaimed emergency medical director, Dr. David K. Tan of St. Charles County Ambulance District in Missouri, discusses complicated EMS patient encounters with the paramedics who were on the scene. From unusual cases, cutting edge interventions, to lessons learned in the field, this is as real as it gets. New episodes every two weeks.
AFTERMATH: Asystole to ROSC After a 60 MPH Ejection | Patient Playback Ep. 6 #ems #podcast
A young patient is ejected from a vehicle at highway speed and found pulseless and apneic with bystander CPR underway. What follows is an intense, rapidly evolving traumatic cardiac arrest resuscitation involving bilateral chest decompression, advanced airway management, ultrasound, defibrillation, prehospital blood products, helicopter EMS—and an extraordinary team effort to achieve ROSC. In this episode of Patient Playback, Dr. David K. Tan sits down with paramedics to break down this challenging trauma case from dispatch through patient handoff.The crew discusses the critical decisions made during the first minutes on scene, including identifying and treating reversible causes of traumatic cardiac arrest. After bilateral chest decompression, the patient's rhythm begins to change. The team continues working through the resuscitation, ultimately achieving return of spontaneous circulation (ROSC).The discussion also explores an important part of emergency medicine that doesn't end when the patient leaves: taking care of the responders who cared for them. The crew discusses the on-scene hot wash, post-call debriefing, peer support, and the emotional impact of treating a critically injured young patient.WATCH OUR LATEST VIDEOS: https://www.youtube.com/watch?v=Bl4tRj5ahHo&list=PLlcQdBrybtgdhlwPduXZ972cyooFq5OnG&index=1&t=181s&pp=iAQBsAgCBe sure to SUBSCRIBE. It helps us reach a larger audience!
00:00 - Introduction 02:46 - Motor Vehicle Accident with High-Speed Ejection06:23 - Initial Assessment & Trauma Arrest 09:19 - Bilateral Finger Thoracotomy & EKG Rhythm Changes 13:07 - Ultrasound, Blood Products, & ROSC 18:27 - Transport Decision: Ground vs. Helicopter24:06 - Post-Incident Psychological First Aid, Peer Support, & Crew Mental Health 34:57 - Case Outcome 39:15 - Key TakeawaysVisit us on social media!www.youtube.com/@sccadtrainingcenterhttps://www.facebook.com/sccadems/https://www.instagram.com/sccadems/https://x.com/sccademshttps://www.linkedin.com/company/sccadems/https://www.youtube.com/sccademsChief Medical OfficerDr. David K. TanProduced by David Dalton, MBAwww.sccad.comPresented by St. Charles County Ambulance District.#organdonation #organdonor #patientplayback #ems #paramedic #firefighter #emergency #ambulance #sccad #sccadems #emergencymedicine #stcharlescountymo #paramedicschool #emt #criticalcareparamedic #paramediclife #criticalcare #emtschool #podcast #traumaarrest #trauma #cardiacarrest# TraumaticCardiacArrest #ROSC #ems #emt #emtb #paramedic #emergencymedicine #ambulance #emergencynursing #nursing #education #training #paramedicschool #nremt #podcast #education #professionaldevelopment #firefighter
14 Sept 2026
Fighting for Air! A Real Paramedic’s Intubation Decision | Patient Playback Episode 5
This episode of "Patient Playback," hosted by Dr. David K. Tan, features a panel of experienced paramedics discussing a critical case involving airway management. The primary learning point focuses on advantages of DSI vs RSI in select emergency situations. The case study involves a cancer patient experiencing severe respiratory distress following an infusion treatment. While clinic staff initially managed the patient as having anaphylaxis, the paramedics suspected something else was at play.
WATCH OUR LATEST VIDEOS: https://www.youtube.com/watch?v=Bl4tRj5ahHo&list=PLlcQdBrybtgdhlwPduXZ972cyooFq5OnG&index=1&t=181s&pp=iAQBsAgCVisit us on social media!www.youtube.com/@sccadtrainingcenterhttps://www.facebook.com/sccadems/https://www.instagram.com/sccadems/https://x.com/sccademshttps://www.linkedin.com/company/sccadems/https://www.youtube.com/sccadems
00:00 Intro
02:25 Patient in Severe Respiratory Distress
03:52 Initial Assessment
04:49 Anxiety Attack or True Respiratory Emergency?
06:57 A Sudden Turn for the Worse
09:02 Fresh Assessment vs. Relying on the Original Diagnosis
09:59 Rapid Sequence Induction (RSI) Indications
12:18 RSI vs. DSI: What's the Difference?
13:14 What RSI Really Means
14:05 Understanding Delayed Sequence Intubation
15:14 Ketamine?
16:06 Patient Response to Treatment
18:24 Preparing for Intubation—If It Becomes Necessary
19:18 DSI Is Not "Slow RSI"
21:13 Why Is There So Much Confusion About DSI?
22:07 Sedation to Improve Oxygenation
24:06 When Avoiding Intubation Is the Better Choice
26:21 How Prehospital Decisions Affect Hospital Outcomes
27:18 Key Takeaways for EMS Providers
29:21 When RSI Is Still the Right Choice
30:25 The Downstream Consequences of Intubation
32:31 Final Thoughts
Chief Medical OfficerDr. David K. TanProduced by David Dalton, MBAwww.sccad.comPresented by St. Charles County Ambulance District.#ems #emt #emtb #paramedic #emergencymedicine #ambulance #emergencynursing #nursing #education #training #paramedicschool #nremt #podcast #education #firefighter #airwaymanagement #intubation
13 Sept 2026
Episode 5 Airs Monday, September 14th! - Teaser
Tune in for "Fighting for Air" on 9/14/26 at 8AM CST.
9 Sept 2026
Episode 5 Preview - Fighting for Air
I the next episode of "Patient Playback," hosted by Dr. David K. Tan, the panel discusses a critical respiratory emergency case. The primary focus is the comparison between RSI and DSI. Tune in on September 14.
31 Aug 2026
Career Longevity & Preventing Burnout | Patient Playback Ep. 4
In this episode of "Patient Playback," Dr. David Tan, Chief Medical Officer for the St. Charles County Ambulance District (SCCAD), hosts a panel discussion with paramedics on the critical topic of career longevity in EMS. The conversation centers on the high stress and burnout common in the profession, noting a significant 67% divorce rate among first responders. A major theme is "compassion fatigue" or "empathy fatigue," which the panel describes as the depletion of a provider's emotional reservoir over a long career. To combat this, the paramedics emphasize the importance of setting firm boundaries by fully disconnecting from work when at home and normalizing debriefs after every call to process experiences. The panel also highlights how organizational culture plays a vital role in retention, giving best practice strategies that lead to higher retention rates. WATCH OUR LATEST VIDEOS: https://www.youtube.com/watch?v=Bl4tRj5ahHo&list=PLlcQdBrybtgdhlwPduXZ972cyooFq5OnG&index=1&t=181s&pp=iAQBsAgCDownload Patient Playback podcasts here:Spotify: https://open.spotify.com/show/5UMnpbKSg5EeNoCXnkHegD?si=e770879a8c6d4571Amazon Music: https://music.amazon.com/podcasts/f88c7b4d-bf94-4f16-b98d-a79e26e20b9a/patient-playback-with-dr-david-k-taniHeart: https://iheart.com/podcast/335758581/Apple Podcasts: https://apple.co/4pkSS1oBe sure to LIKE, SUBSCRIBE, and hit the NOTIFICATION bell to receive updates on new content!00:00 Introduction02:18 What Does EMS Career Longevity Really Mean?05:00 Protecting Your Empathy & Preventing Compassion Fatigue11:18 Setting Boundaries 12:00 Why Low-Acuity Calls Can Lead to Burnout17:07 Building a Career That Lasts 30 Years18:45 Creating Multiple Career Paths in EMS26:31 Investing in Education & Professional Growth29:08 Why Workplace Culture Matters31:21 What Employees & Employers Can Do39:54 Creating a Just Culture for EMS Providers47:17 The Keys to a Long EMS Career50:32 Final ThoughtsVisit us on social media!www.youtube.com/@sccadtrainingcenterhttps://www.facebook.com/sccadems/https://www.instagram.com/sccadems/https://x.com/sccademshttps://www.linkedin.com/company/sccadems/https://www.youtube.com/sccademsChief Medical OfficerDr. David K. TanProduced by David Dalton, MBAwww.sccad.comPresented by St. Charles County Ambulance District.#ems #emt #emtb #paramedic #emergencymedicine #ambulance #emergencynursing #nursing #education #training #paramedicschool #nremt #podcast #education #professionaldevelopment #firefighter #burnout #retentionstrategies paramedic retention, ems staffing crisis, why emts quitASLC-4F2E1A8B-7828412DA7
30 Aug 2026
Episode 4 Airs Monday, August 31st - Teaser
Patient Playback Airs Monday, August 31st on your favorite podcast platforms.
EMS Burnout and Staffing Crisis #paramedic #ambulance #staffing #burnoutprevention #emt #podcast
28 Aug 2026
EMS Burnout Prevention - Teaser
Episode 4 Airs Monday, August 31.
17 Aug 2026
What is a Patient? | Patient Playback Ep 3
Dispatched to a "minor" car accident, EMT finds the driver out of the car claiming he's fine. The crew leaves, and two hours later, the man loses consciousness from internal bleeding. Is a lawsuit in the crew's future?
Having a clear, simple definition of "patient" may seem silly, but mountains of case law prove otherwise.
In this episode, Dr. Tan and a panel of paramedics discuss ways providers can protect themselves and their "patients."
00:00 Intro
03:05 Do We Need A Definition?
06:49 What Does Having A Definition Accomplish?
07:03 The 6 Criteria That Define a Patient
08:45 Practical Application
11:50 Getting to the Truth
14:58 What is a "Safe Place Move"? Do We Need to Document It?
20:31 The Pitfalls of Falls
28:20 Coping with Burnout, Fatigue, and Other Barriers to Going the Extra Mile
35:11 Non-Injury Doesn't Mean Non-Patient
42:40 Involuntary Patients & Provider Safety
49:40 Wrap-Up
10 Aug 2026
Teaser - What is a "Patient"?
Coming August 17, 2026 at 8AM
3 Aug 2026
Sick Case Detectives | Patient Playback Ep 2
EMT's and Paramedics are routinely taught to look for "clues" on every scene to figure out what's wrong with the patient. However, some clues are easier to spot than others. In this episode, paramedics recount a mystery where one vital clue and a new treatment approach made all the difference.
00:00 Intro
02:23 The Usual "Clues"
03:26 The Case
09:30 The Smoking Gun
12:12 The Solution
18:51 The Outcome
22:23 Dual Process Theory
24:10 High-Density Decision Phase
25:46 Scene management tips for high acuity calls
31:58 Tips for students and new EMTs/paramedics
37:11 Peri-intubation critical steps
38:57 Wrap-up
Visit us on social media!
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21 Jul 2026
Teaser - Sick Case Detectives
On the next episode of Patient Playback with Dr. David K. Tan...
Premieres August 3, 2026
3 Jun 2026
The Paradigm Shift in Traumatic Circulatory Arrest | Patient Playback Ep 1
Survival rates for traumatic circulatory arrest (TCA) are historically low. Dr. David K. Tan explains why standard CPR compressions without fluid volume interventions are futile in these settings. The panel discusses strategies for increasing survivability, how EMS services can implement their own prehospital blood program in spite of limited financial resources, how and when to use ultrasound (POCUS) appropriately, how to apply pit-crew dynamics, how to decide between terminating or continuing resuscitation efforts, and how to address the psychological and emotional impact these calls can have on rescuers.
00:00 (https://www.youtube.com/watch?v=Bl4tRj5ahHo) Introduction03:00 (https://www.youtube.com/watch?v=Bl4tRj5ahHo&t=180s) Prehospital Trauma Compendium: Prehospital Management of Traumatic Circulatory Arrest.05:50 (https://www.youtube.com/watch?v=Bl4tRj5ahHo&t=350s) How do medics feel about withholding compressions?10:17 (https://www.youtube.com/watch?v=Bl4tRj5ahHo&t=617s) HOTT to reversible causes.15:28 (https://www.youtube.com/watch?v=Bl4tRj5ahHo&t=928s) point of care ultrasound (POCUS).23:05 (https://www.youtube.com/watch?v=Bl4tRj5ahHo&t=1385s) Team Dynamics: prehospital blood and rapid transport.29:40 (https://www.youtube.com/watch?v=Bl4tRj5ahHo&t=1780s) Whole blood vs. component therapy.35:27 (https://www.youtube.com/watch?v=Bl4tRj5ahHo&t=2127s) When to terminate resuscitation.42:40 (https://www.youtube.com/watch?v=Bl4tRj5ahHo&t=2560s) Team well-being & psychological first aid.55:50 (https://www.youtube.com/watch?v=Bl4tRj5ahHo&t=3350s) Conclusion
Recorded May 29, 2026.
Hosted by Dr. David K. Tan
Produced by David Dalton, MBA
www.sccad.com
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