The FlightBridgeED Podcast

We’re continuing our FAST Replay series, bringing you full sessions recorded live from past FAST conferences as we build toward FAST26: Austin. This episode features Jeff Jarvis and covers a wide range of topics that directly address how we practice in EMS.
From trauma care to airway to cardiac arrest, this session walks through current position statements and evolving recommendations, including:
 Blood product use in trauma 
 How to approach traumatic (circulatory) arrest 
 Pneumothorax and chest decompression decisions 
 Postpartum hemorrhage and hypertension management 
 Airway timing and first-pass success 
 And where some of our long-standing practices don’t hold up to the evidence 
More than anything, this talk highlights a core idea: not everything we do in EMS is built on strong evidence, and we need to be willing to question and refine our approach as new data emerge.
FAST26 is coming to Austin this year on May 27 - 29, 2026. We are co-locating with EMS World Live, bringing together the entire EMS community with FAST26: Austin and EMS World Live Austin, giving you the very best of every possible aspect from basics to critical care to administration!
👉 Learn more or grab your spot at https://fbefast.com

This episode focuses on the critically ill patient with pulmonary arterial hypertension (PAH) and explains why this subgroup is especially dangerous in emergency and transport medicine. Dr. Mike Lauria distinguishes PAH from the broader label of “pulmonary hypertension,” emphasizing that elevated pulmonary pressures can come from several very different disease processes, but group 1 PAH is a rare intrinsic disease of the pulmonary arteries that creates fixed resistance to blood flow. Over time, this chronic increase in pulmonary vascular resistance places an enormous burden on the right ventricle, which may initially compensate but can eventually dilate and fail, especially when stressed by infection, hypoxia, medication interruption, or other acute illness. 
A major theme of the episode is that right ventricular failure is the central problem when these patients decompensate. Dr. Lauria reviews how rising RV afterload leads to RV dilation, reduced RV output, impaired LV filling, worsening cardiac output, and eventual shock. He also highlights an important practical pearl: many PAH patients depend on specialized outpatient therapies such as endothelin receptor antagonists, PDE-5 inhibitors, and especially continuous prostacyclin infusions like epoprostenol or treprostinil. Abrupt interruption of these medications can trigger rebound pulmonary hypertension and rapid deterioration, making continuation of home therapy a critical part of transport and ICU management. 
Management is framed around supporting the failing RV while avoiding interventions that can worsen hemodynamics. The speaker recommends maintaining MAP, usually with norepinephrine, carefully managing preload, and recognizing that this is one of the few shock states where patients may need both vasopressors and diuresis. The episode strongly warns against aggressive fluid loading, stresses the importance of correcting hypoxia and hypercapnia, and supports use of inhaled pulmonary vasodilators such as nitric oxide or epoprostenol in the right setting. It also cautions that intubation is particularly dangerous in PAH because induction and positive-pressure ventilation can sharply worsen RV function and precipitate cardiovascular collapse. 
Key points
 The episode distinguishes group 1 pulmonary arterial hypertension from the broader and more nonspecific category of pulmonary hypertension. 
 PAH is dangerous because it creates fixed pulmonary vascular resistance, which can eventually cause right ventricular failure and shock. 
Medication interruption, especially stopping continuous prostacyclin infusions, can cause rebound pulmonary hypertension and sudden collapse. 
 Management focuses on supporting the RV: maintain MAP, avoid unnecessary fluids, optimize oxygenation and ventilation, and consider inhaled pulmonary vasodilators. 
Intubation is high risk in these patients because positive pressure and induction can worsen RV afterload and trigger hemodynamic collapse.

This episode reviews the newly released 2026 pulmonary embolism guidelines with an emphasis on what matters most for critical care and transport clinicians: identifying the sickest PE patients early and recognizing how quickly they can deteriorate. Dr. Michael Lauria stresses that although pulmonary embolism is common, the subset with hemodynamic instability carries very high mortality and often requires transfer for advanced therapies such as ECMO, catheter-based intervention, or surgery. 
A major focus is the new classification system, which replaces the older “massive” and “submassive” terminology with categories A through E. Instead of emphasizing clot size, the new framework centers on clinical severity, especially hypotension, end-organ hypoperfusion, and progression toward cardiopulmonary failure. The episode also highlights that severe PE is fundamentally a problem of right ventricular failure: as pulmonary vascular resistance rises, the RV dilates, perfusion worsens, LV filling drops, and the patient can spiral into shock. 
Management is therefore framed around supporting the failing RV while moving toward definitive reperfusion. The speaker recommends maintaining perfusion pressure, avoiding aggressive fluids, optimizing oxygenation, reducing RV afterload, and using inotropic support when needed, while also warning that intubation and positive pressure can worsen hemodynamics in these patients. For the sickest patients, especially category D and E PE, systemic thrombolysis is presented as the main reperfusion option available in many settings, though it remains underused and carries meaningful bleeding risk, including intracranial hemorrhage. 
Key points
 The episode centers on the new 2026 PE guidelines and their practical relevance for emergency, ICU, and transport care. 
 The old “massive/submassive” terms are replaced by categories A through E, with D and E representing the highest-risk patients. 
 Severe PE is dangerous primarily because of right ventricular failure and shock, not just hypoxia. 
 Initial treatment focuses on supporting the RV: maintain MAP, avoid excess fluids, improve oxygenation, reduce RV afterload, and add inotropy when needed. 
Systemic thrombolysis is a key reperfusion therapy for the sickest patients, but it is underused and has significant bleeding risks.

We’re continuing our FAST Replay series, bringing you full sessions recorded live from past FAST conferences as we build toward FAST26: Austin. This episode is a talk from FAST25: Lexington that covers a lot of ground, but it all comes back to one question: Why are we doing what we’re doing?

From cardiac arrest to seizures to traumatic arrest, this session challenges some of the most common practices in EMS:
 Amiodarone vs. lidocaine 
 How we’re actually dosing benzodiazepines 
 When ketamine makes more sense 
 And whether epinephrine is helping at all in traumatic cardiac arrest 
This isn’t about memorizing protocols. It’s about understanding the reasoning behind them and being willing to question them when the evidence doesn’t hold up. If you’ve ever felt like something didn’t quite add up in your protocols… this one will hit.
This is what FAST sounds like. Real conversations. Real challenges. Live from the room.
FAST26 is coming to Austin this year, co-located with EMS World Live, bringing together the FAST experience with a broader EMS community, while keeping what makes FAST what it is.
👉 Learn more or grab your spot:
 https://fbefast.com
FAST26: Austin will be in Austin, Texas, from May 27 - 29, 2026.
Tickets are available as FAST26: Austin only, EMS World Live only, or a combination ticket that allows you to attend both events.

We’re continuing our FAST Replay series, bringing you full sessions recorded live from past FAST conferences as we build toward FAST26: Austin! This episode takes on a topic everyone talks about… but few fully understand: evidence-based medicine. What does it actually mean in EMS?

This session breaks it down in a way that’s practical, honest, and directly applicable to how decisions get made in the field. From the limits of single studies to the importance of real-world context to the evolution of guidelines and what drives them. This is a deeper look at how evidence should (and shouldn’t) shape practice. It also challenges some long-standing habits in medicine, where tradition, opinion, or “how we’ve always done it” have influenced care just as much as actual evidence. If you’ve ever heard “the evidence says…”, this episode might change how you think about that.
This is what FAST sounds like. Real conversations. Real ideas. Live from the room. FAST26 is coming to Austin, Texas this year on May 27-29, 2026. We are co-locating with EMS World Live, giving you 2 HUGE events under 1 roof at the same time! Choose to join one, or the other, or come to both!
👉 Learn more or grab your spot: https://fbefast.com
Enjoy this talk from Eddy Lang! See you in Austin!