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PODCAST

Heavy Lies the Helmet

Mike Boone, Dan Rauh, & Dr. Amanda Humphries

The Heavy Lies the Helmet® Podcast is by critical care professionals, for critical care professionals. Hosted by Mike Boone, Dan Rauh, and Dr. Amanda Humphries, we dive deep into the realities of emergency and critical care medicine. Our conversations are raw, honest, and practical — cutting through the noise to focus on real-world challenges, clinical decision-making, and the human side of high-acuity care. Whether we"re unpacking complex patient scenarios, discussing the nuances of teamwork and

health & fitness medicine

All Episodes

58:16

Episode 134 - Giving Patients Room to Breathe...

Heavy Lies the Helmet ·

2025/11/21

Mechanical ventilation doesn't have to feel like wizardry. In this podcast episode, we strip it back to what really matters—simple mental models, clean decision-making, and an approach that works whether you're in the back of a helicopter, a tight ambulance box, or a chaotic ED bay. We walk through the foundational concepts and the "why" behind each knob you touch. Then we zoom in on the Hamilton T1, the vent many of us love, hate, and still rely on every single shift. We cover what the T1 gets

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46:38

Episode 133 - Tracheostomy: The Neck's Best Thing

Heavy Lies the Helmet ·

2025/10/03

Tracheostomies are increasingly common in both prehospital and critical care transport settings, but they come with unique challenges. In this podcast episode, we break down short-term and long-term complications you may encounter, and how to troubleshoot them in high-stakes environments. From occlusions and dislodgements to bleeding, we’ll cover practical strategies to keep these vulnerable patients safe. Whether you’re new to airway management or a seasoned clinician, this discussion will sharpen

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54:29

Episode 132 - Prolonged Flight Care w/Anyone Not...

Heavy Lies the Helmet ·

2025/08/18

What happens when resources are limited, transport is delayed, or you’re forced to manage a critically ill patient far beyond the typical flight window? In this podcast episode, Brett Weiner and Dr. Tim Hurtado help us dive into the challenges and realities of prolonged field care in air medical transport. We’ll explore clinical considerations, crew dynamics, and decision-making strategies that can help you maintain high-quality care when time isn’t on your side. We’re also excited to announce our

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54:54

Episode 131 - TXA: The Clot Thickens

Heavy Lies the Helmet ·

2025/07/14

Tranexamic Acid (TXA) is a lot like hot sauce: People put it on everything — especially for apparent or suspected acute blood loss. In this podcast episode, we dive into a drug that’s been both praised and questioned in trauma and prehospital care. We break down what TXA is, how it works, and the evidence behind its use. From CRASH-2 to CRASH-3, we explore the key studies, the controversies, and the real-world implications. Whether you’re administering TXA in the back of a rig or evaluating its role

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01:10:08

Episode 130 - Opinion-Based Medicine w/Mike Carunchio

Heavy Lies the Helmet ·

2025/06/13

Though evidence dictates much of what we do as emergency medical providers, some areas remain open to debate: How are we justifying stroke ambulances, CCT speciality teams, AHA guidelines, and our choice of crystalloids? How are we justifying what professionals are allowed to post on social media? And do we agree with the currently accepted norms? Who better to join us in this discussion than Mike Carunchio of The World's Okayest Medic Podcast. Diving into these and other controversial topics, we

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01:07:36

Episode 129 - Little Lung Problems w/Nate Brown

Heavy Lies the Helmet ·

2025/05/20

Wet or dry. Air in or out. Reactive or obstructive. The possibilities may seem endless when treating the pediatric patient with undifferentiated respiratory distress. It is confounded by the fact that pediatrics are outside the comfort zone of many novice critical care transport providers. In this podcast episode, neonatal/pediatric specialist Nate Brown eases your worries with concise and effective means of diagnostics and intervention. Primarily, we cover croup, bronchiolitis, and asthma disease

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55:14

Episode 128 - Keeping Trauma Close to the Chest

Heavy Lies the Helmet ·

2025/04/09

'Tis the season for trauma. (If there truly is a season.) Chest trauma, specifically, can vary in subtlety and severity, primarily due to the presence of multiple vital organs and vessels. In this podcast, we discuss these potentials while focusing on those injuries that are associated with the highest mortality rate. We also discuss why you should think twice before intervening. Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet Facebook

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43:09

Episode 127 - P.R.E.S. Sure

Heavy Lies the Helmet ·

2025/02/24

Does your patient have high blood pressure? Are they seizing or showing other signs of a neurological disorder? It could be PRES! Unfortunately, Posterior Reversible Encephalopathy Syndrome (PRES) is difficult to diagnose unless you are aware of its existence. In this podcast episode, we discuss this infrequent condition and how can you appropriately diagnose and treat it. Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet Facebook

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50:47

Episode 126 - Certification Versus Qualification

Heavy Lies the Helmet ·

2025/01/23

Do certifications accurately reflect an individual's qualifications? This is an ongoing argument depending on what side of the exam you are on. How much value should we on that piece of paper? And, regardless, how do we work towards obtaining and maintaining qualifications? In this podcast episode, we discuss it all including Dunning-Kruger Effect and Hierachy of Competence. We also delve into teaching strategies that can help newcomers gain their confidence after achieving whatever got them there

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45:05

Episode 125 - Breaking the Case: The Point of Ultrasound

Heavy Lies the Helmet ·

2024/12/24

Previously, we recorded a podcast episode about the utility surrounding Point of Care Ultrasound (POCUS). In this episode, we apply that knowledge to specific case scenarios as a continuation of our "Breaking the Case" series. We also ask the question, is POCUS really all it's cracked up to be, or should we be re-thinking our approach, particularly in the prehospital setting? Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet Facebook

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56:54

Episode 124 - Canine Care w/George Tarver III

Heavy Lies the Helmet ·

2024/11/18

Humans are easy. That's why we are able to do what we do as prehospital providers. But what happens when your patient is a canine? These working dogs are highly regarded by their handlers and require care just like anyone else that may be ill or injured. Considering that, are you equipped to care for them? If not, how can you successfully start and maintain a K9 program at your agency? Tune in to another podcast to discuss this unique topic, but this time, we are joined by HLTH team member Rick

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01:00:03

Episode 123 - To Treat or Not to Treat: Hypertension

Heavy Lies the Helmet ·

2024/10/21

It can be difficult to determine whether you should treat undifferentiated hypertension or not. Many clinicians are distracted the number rather than focusing on the patient in front of them. Asymptomatic hypertension, in particular, is often benign. In fact, treating asymptomatic hypertension in a patient who a primary medical history of hypertension can harm them. In this podcast, we discuss these adverse effects related to blood pressure physiology, acute versus chronic hypertension, and how you

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01:01:23

Episode 122 - Stay Positive When Preoxygenating...

Heavy Lies the Helmet ·

2024/09/30

The principles of preoxygenation and passive oxygenation should be familiar to any experienced intubator. Best practice recommends the use of a nasal cannula in conjunction with either a non-rebreather mask or bag-valve mask (BVM) to prevent hypoxemia during the apneic phase of Rapid Sequence Intubation (RSI). In the PREOXI Trial, the authors pushed this concept further, questioning whether non-invasive positive pressure ventilation (NIPPV) might be more effective than these formally mentioned

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46:51

Episode 121 - Outside the Box: Cardiac Arrest Management

Heavy Lies the Helmet ·

2024/08/22

Not all cardiac arrests are created equal. Whether the presenting rhythm is asystole, ventricular fibrillation, or PEA, these patients require tailored interventions beyond "blanket" protocol and ACLS/PALS algorithms. When refractory to conventional therapy, the pulseless V-Tach/V-Fib patient, in particular, requires critical thinking "outside the box" in order to gain ROSC (Return of Spontaneous Circulation) and preserve neurological outcomes. What are some of the measures we can consider when

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01:04:17

Episode 120 - Sorry, We Are Closed: Interfacility...

Heavy Lies the Helmet ·

2024/06/29

Interfacility transfers are not always indicated at the time and place of which they are being requested. Whether it's referring provider misinformation or a lack of advocacy by the transport agency, these transfers can result in unnecessary risk for crew members and patients. Specifically, weather conditions, time of day, crew fatigue, and other important factors are not always considered when blindly accepting these transfers. As the transport specialists, how can we ensure that we are accepting

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43:50

Episode 119 - Losses and Gains: Antidiuretic Hormone

Heavy Lies the Helmet ·

2024/05/06

Antidiuretic hormone (ADH) plays an essential part in the body's osmotic/fluid balance, sodium homeostasis, and blood pressure regulation. This hormone is synthesized in the hypothalamus and released from the posterior pituitary gland. In conditions such as Diabetes Insipidus (DI) and Syndrome of Inappropriate ADH (SIADH), there is a lack of synthesis or over-production of this hormone which results in negative downstream effects. At the request of a podcast listener, we have decided to cover these

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46:54

Episode 118 - Trigger Warning: Angioedema

Heavy Lies the Helmet ·

2024/03/25

Angioedema is defined by upper airway swelling secondary to an immune response. The trigger and subsequent physiological response are how we categorize it. In this podcast, we discuss how to diagnose and treat both types: IgE/Histamine-mediated and Bradykinin-mediated. We also touch on how to address the difficult airway that may or may not lead to intubation. All in all, do not fear angioedema but respect it. Get CE hours for our podcast episodes HERE! --------------------------------------------

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50:56

Episode 117 - Dye or Die: Methylene Blue w/Will Heuser

Heavy Lies the Helmet ·

2024/02/28

When discussing methylene blue, management and treatment of methaemoglobinaemia is usually the first indication mentioned. But in this podcast, we challenge you to increase the size of your lense and focus on its benefits in other states (e.g., septic shock). Of course, we could not do this alone, so we invited a Flight Paramedic, Pharmacist, Toxicologist, and Professor to join us. And fortunately for us, they are all the same person. Tune in as Will Heuser helps us discuss the pathophysiology of

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58:23

Episode 116 - Around the World: HEMS in México...

Heavy Lies the Helmet ·

2024/01/27

Though we have delved into foreign HEMS systems in the past (See Episode 61 – Down Under Dynamics w/Dr. Cliff Reid), we have not dedicated an entire series to it. Having now rubbed shoulders with many clinicians and operators around the world, it is evident that these conversations need to take place on a regular basis. Why? Because operating in a vacuum can lead to bad decision making. Our new "Around the World" series attempts to mitigate this by interviewing prehospital and intrahospital

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01:06:59

Episode 115 - Me, My Self-Loading Baggage, and I...

Heavy Lies the Helmet ·

2023/12/20

"Self-loading baggage" is a derogatory term often used by pilots to describe lazy or disengaged medical crew members in the air medical industry. Whether intentional or not, this behavior sets a bad precedent for those of us that want to embrace aviation cross-training and be able to assist the pilot effectively. In this podcast episode, we are joined by pilots Miles Dunagan and Brett Reeder to discuss how pilots and clinicians alike can be a cohesive team before, during, and after the flight. We

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