Stillwater Medical Professional Development

11/29/2025

Great lessons for us all.

⭐ 6 Leadership Lessons EMS Taught Me This Year

Small habits. Big impact. Built on shift after shift.

No one really prepares you for how much leadership matters in EMS. Not the rank, not the title — the presence. The small behaviors. The tone you bring into the room. This year, EMS taught me more about leadership than any book, classroom, or certification ever could.

Here are the six lessons that changed the way I lead on scene, in the station, and with the people beside me.

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1. Professionalism is a clinical skill.

Your tone, posture, and attitude are interventions just as important as anything in your jump bag.
People follow the energy you bring into the room — for better or worse. And when the scene is loud, hectic, or emotionally charged, professionalism becomes a stabilizing force.

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2. Ask better questions.

Curiosity is maturity.
Questions are not a sign of insecurity — they’re the sign of someone who refuses to stop learning.
The leaders who ask “why?” and “show me” are the same leaders who make safer decisions and build stronger teams.

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3. Confidence comes from repetition.

Not from pretending.
Not from perfection.
Only from practice → clarity → confidence.
The more you see, do, reflect, and refine, the more your decisions become grounded instead of guessed.

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4. Culture is built in tiny moments, over time.

How you speak on scene.
How you treat new people.
How you handle stress.
How you engage with your crew.
Culture isn’t made in meetings — it’s made in the everyday behaviors people see and feel.

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5. The best providers make everyone else better.

Skill makes you competent.
But lifting the people around you?
That’s exceptionalism.
The leaders who strengthen their partners create ripple effects that move through entire shifts, stations, and systems.

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6. Control the space without dominating it.

Guide. Delegate. Elevate others.
Leadership is shared, not hoarded.
You don’t need to be the loudest voice to be the one people trust — you just need to be the most intentional.

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⭐ What This All Means

We don’t grow in EMS because someone hands us a title.
We grow because we learn to lead with presence, clarity, and purpose — one moment at a time.

If you’re on that journey too, these lessons are for you. You’re not behind. You’re becoming.

11/28/2025

Here’s what I tell the people I mentor:

You don’t get better with kids by being fearless.
You get better by being prepared, supported, and taught—one experience at a time. Your confidence comes from repetition, knowledge, and having someone beside you who keeps the scene calm even when the stakes feel sky-high.

A good mentor doesn’t just show you what to do with a sick child.
They show you how to think.

They teach you to slow your breath so you can hear the tiny details: a quiet cry, a retraction, a change in tone.
They remind you that kids crash fast but respond fast too.
They walk you through dosing until math becomes muscle memory, not panic.
They teach you that sick vs. not sick is the first vitals sign.
They help you build a pediatric lens—not fear, but focus.

And they don’t shame you for the nerves.
They normalize them.
They say, “You’re human. This is hard. But you are capable.”
Because confidence in pediatrics isn’t born from perfection.
It’s built from support.

The tough mentors—the ones who belittle or say, “It’s just a kid, you’ll figure it out”—they don’t produce stronger medics.
They produce quieter ones.
And nothing in pediatrics should be quiet except your mind in the moment you need to act.

So here’s the guidance I wish every new provider received:
• Have Access to your dosing routes and options before the call ever drops. You don’t need it memorized.
• Trust your gut—kids are honest; if they look bad, they are bad.
• Keep the parents close, not away. They give you more information than a monitor ever could.
• Small victories matter. A warmed blanket, bubbles, a calm voice—these aren’t minor, they’re essential.

Most of all:
You don’t have to be fearless to be good at pediatrics.
You just need someone willing to teach you the way they wish someone taught them.

And one day, you’ll be that person for someone else—the steady voice, the calm presence, the mentor who turns fear into focus.

11/26/2025

🔥 𝐏𝐄𝐃𝐈𝐀𝐓𝐑𝐈𝐂 𝐏𝐑𝐄-𝐀𝐑𝐑𝐄𝐒𝐓 𝐑𝐄𝐂𝐎𝐆𝐍𝐈𝐓𝐈𝐎𝐍

👶🚑 𝐂𝐚𝐭𝐜𝐡 𝐭𝐡𝐞 𝐜𝐡𝐢𝐥𝐝 𝐰𝐡𝐨 𝐧𝐞𝐞𝐝𝐬 𝐚𝐠𝐠𝐫𝐞𝐬𝐬𝐢𝐯𝐞 𝐫𝐞𝐬𝐮𝐬𝐜𝐢𝐭𝐚𝐭𝐢𝐨𝐧 𝐛𝐞𝐟𝐨𝐫𝐞 𝐭𝐡𝐞𝐲 𝐜𝐫𝐚𝐬𝐡

You do not regret acting early.
You regret waiting.

Kids hide shock until they cannot.
Your job is to spot the pattern before collapse.

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🚨 𝐖𝐇𝐘 𝐓𝐇𝐈𝐒 𝐌𝐀𝐓𝐓𝐄𝐑𝐒

• More than 60 percent of pediatric arrests show abnormal vitals before collapse.
• Each abnormal vital increases the odds of deterioration and ICU transfer.
• Hypotension is a late marker in kids.
• Early care improves survival only when you catch shock early.

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🔬 𝐖𝐇𝐀𝐓 𝐈𝐒 𝐇𝐀𝐏𝐏𝐄𝐍𝐈𝐍𝐆 𝐈𝐍𝐒𝐈𝐃𝐄 𝐓𝐇𝐄𝐌

❤️ Cardiovascular changes

• Kids depend on heart rate to keep cardiac output up.
• They cannot raise stroke volume much.
• Once tachycardia fails, cardiac output drops fast.

🦠 Septic changes

• Vessels relax.
• Fluid leaks from the vascular space.
• Preload falls.
• Anaerobic metabolism rises.
• Lactate climbs.

💧 Hypovolemic changes

• Low preload triggers vasoconstriction.
• Skin and gut lose blood flow early.
• Pulse pressure narrows.
• Cellular function declines.

🥶🔥 Warm and cold shock

• Warm shock can show bounding pulses and a wide pulse pressure.
• Cold shock shows weak pulses and delayed refill.
• Both patterns progress to organ injury.

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🚩 𝐑𝐄𝐃 𝐅𝐋𝐀𝐆𝐒 𝐘𝐎𝐔 𝐒𝐇𝐎𝐔𝐋𝐃 𝐀𝐂𝐓 𝐎𝐍

👀 Appearance and perfusion

• Cap refill more than 3 seconds
• Cool or mottled skin
• Flash refill with wide pulse pressure
• Weak pulses
• Low urine output
• Irritability or lethargy

❤️‍🔥 Heart rate and blood pressure

• Tachycardia after treating fever and pain
• Infant: above 180
• Toddler: above 160
• School age: above 140
• RR above normal for age
• SBP lower than 70 + 2 × age in years

🧪 Labs and trends

• Lactate 4 or higher
• Rising lactate
• Worsening acidosis
• Increasing oxygen needs

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👨‍👩‍👧 𝐏𝐀𝐑𝐄𝐍𝐓 𝐂𝐋𝐔𝐄𝐒 𝐘𝐎𝐔 𝐒𝐇𝐎𝐔𝐋𝐃 𝐓𝐑𝐔𝐒𝐓

Parents often spot trouble first.

• “He is not himself.”
• “She is too sleepy.”
• “He never breathes like this.”
• “She stopped playing.”

Treat these statements as clinical data.

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📊 𝐒𝐇𝐎𝐂𝐊 𝐈𝐍𝐃𝐄𝐗 (𝐒𝐈𝐏𝐀)

Shock Index = HR ÷ SBP

• High SIPA predicts higher mortality and ICU use.
• A high index with normal BP still signals instability.
• Mortality rises sharply once SIPA exceeds age cutoffs.

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🧠 𝐏𝐄𝐃𝐒 𝐏𝐑𝐄-𝐀𝐑𝐑𝐄𝐒𝐓 𝐂𝐇𝐄𝐂𝐊

✔️ Full Algorithm

Step 1. Three fast questions

• Does this child look sick.
• Are two or more vitals abnormal.
• Is perfusion or mental status abnormal.

One yes means reassess fast.
Two or more yes means unstable.

Step 2. Numbers you need

• HR, RR, BP, SpO₂
• Central and peripheral cap refill
• Shock index
• Blood glucose
• Lactate

Step 3. Identify the pattern

💧 Hypovolemic
• Fluid loss
• Narrow pulse pressure
• Cool extremities
• Delayed refill

🦠 Septic
• Fever or infection
• Warm bounding pulses or cold mottled skin

❤️ Cardiogenic
• Cardiac disease
• Hepatomegaly
• Rales
• Worse after fluids

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💦 𝐖𝐇𝐄𝐍 𝐓𝐎 𝐒𝐓𝐀𝐑𝐓 𝐅𝐋𝐔𝐈𝐃𝐒

Start fluids when you see

• Tachycardia with cold extremities
• Narrow pulse pressure
• Delayed refill
• History of fluid loss
• No overload signs

Slow fluids when you see

• New rales
• Rising liver edge
• Increased work of breathing
• Known cardiac disease
• Shock after boluses

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⚠️ 𝐃𝐎 𝐍𝐎𝐓 𝐌𝐈𝐒𝐒 𝐂𝐀𝐑𝐃𝐈𝐎𝐆𝐄𝐍𝐈𝐂 𝐒𝐇𝐎𝐂𝐊

• Tachycardia with hepatomegaly
• Rales with poor perfusion
• New fatigue after viral illness
• Chest pain with tachycardia
• Shock worse after fluids

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🛑 𝐍𝐄𝐕𝐄𝐑 𝐃𝐎 𝐓𝐇𝐈𝐒

• Never wait for hypotension.
• Never give repeated boluses without reassessment.
• Never ignore a high shock index.
• Never assume fever explains tachycardia.
• Never let a sick child out of sight.

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⏱️ 𝐅𝐈𝐑𝐒𝐓 𝟓 𝐓𝐎 𝟏𝟎 𝐌𝐈𝐍𝐔𝐓𝐄𝐒 𝐎𝐅 𝐀𝐂𝐓𝐈𝐎𝐍

Airway and breathing

• Oxygen
• Position and suction
• Prepare for early intubation if mental status drops

Circulation

• IV or IO
• 10 to 20 ml per kg crystalloid in 5 to 10 minutes
• Reassess after each bolus
• Up to 40 to 60 ml per kg in the first hour if no overload

Watch for overload

• Rales
• Rising liver edge
• New respiratory distress

Vasoactives

• Cold septic or hypovolemic
• Epinephrine
• Warm septic
• Norepinephrine
• Cardiogenic
• 5 to 10 ml per kg boluses
• Epinephrine or dobutamine

Sepsis care

• Antibiotics within 60 minutes
• Control source
• Track lactate and urine output

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🚑 𝐓𝐑𝐀𝐍𝐒𝐏𝐎𝐑𝐓 𝐂𝐔𝐄𝐒

If the child needs vasoactives, an advanced airway, or more than two boluses, transport at a higher level than standard ALS.

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🧰 𝐏𝐄𝐃𝐒 𝐂𝐑𝐀𝐒𝐇 𝐂𝐀𝐑𝐃

Quick Tool

Step A. Count abnormal vitals

Two or more means high risk.

Step B. Check perfusion and brain

• Cap refill
• Extremity temperature
• Pulses
• Interaction
• Speech
• Urine output
Any abnormal is a red flag.

Step C. Shock index

Shock Index = HR ÷ SBP
High for age means unstable.

Step D. Shock pattern

• Hypovolemic
• Septic
• Cardiogenic

Step E. First hour

• Oxygen
• Fluids as needed
• Vasoactives early
• Antibiotics within 60 minutes
• Escalate early

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📘 𝐀𝐆𝐄 𝐑𝐀𝐍𝐆𝐄𝐒 𝐂𝐇𝐄𝐀𝐓 𝐂𝐀𝐑𝐃

• Infant: 0 to 12 months
• Toddler: 1 to 3 years
• Preschool: 3 to 5 years
• School age: 6 to 12 years
• Teen: 13 and older

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🔥 𝐅𝐈𝐍𝐀𝐋 𝐓𝐇𝐎𝐔𝐆𝐇𝐓

Kids do not give long warnings.
Their numbers look normal until they do not.
Your speed matters. Your pattern recognition matters even more.
If you see two abnormal vitals, abnormal perfusion, or a high shock index, you should act.
Early care is disciplined action.
You save lives by refusing to wait for collapse.
Your job is not perfect prediction.
Your job is early action before the child pays the price for silence.
Hold the line. Protect the minutes that matter.

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📚 𝐑𝐄𝐅𝐄𝐑𝐄𝐍𝐂𝐄𝐒

Akre, M., Finkelstein, M., Erickson, M., Liu, M., Vanderbilt, L., & Billman, G. (2010). Sensitivity of the Pediatric Early Warning Score to identify hospitalization among children in the emergency department. Journal of Hospital Medicine, 5(6), 312–318.

Balamuth, F., Weiss, S. L., Neuman, M. I., Scott, H., Brady, P. W., Paul, R., … Alpern, E. R. (2019). Pediatric severe sepsis in U.S. children’s hospitals. Pediatrics, 144(6), e20190505.

Davis, A. L., Carcillo, J. A., Aneja, R. K., Deymann, A. J., Lin, J. C., Nguyen, T. C., … Yeh, T. (2017). American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Pediatrics, 140(6), e20174081.

de Oliveira, C. F., de Oliveira, D. S. F., Gottschald, A. F., Moura, J. D. G., Costa, G. A., Ventura, A. M., … Rivers, E. P. (2008). ACCM/PALS hemodynamic support guidelines for pediatric septic shock. Critical Care Medicine, 36(6), 172–178.

de Souza, D. C., Shieh, H. H., Saraiva, F. A., & Silva, C. A. (2017). Epidemiology of septic shock in children. Pediatric Critical Care Medicine, 18(10), e483–e488.

Sankar, J., Ismail, J., Sankar, M. J., Censier, T., & Dubey, N. (2018). Pediatric age-adjusted shock index as a predictor of mortality. Journal of Intensive Care Medicine, 33(11), 676–683.

Scott, H. F., Brou, L., Bryant, K., & Moore, K. (2017). Lactate clearance and outcomes in pediatric sepsis. Pediatric Emergency Care, 33(10), 650–654.

Venturini, S., Bergamini, B. M., Jala, L., & Rolando, N. (2016). Hypotension in pediatric sepsis. Journal of Pediatrics, 169, 191–197.

Weiss, S. L., Fitzgerald, J. C., Pappachan, J., Wheeler, D., Jaramillo-Bustamante, J. C., Salloo, A., … Thomas, N. J. (2014). Delayed antimicrobial therapy increases mortality in pediatric septic shock. Critical Care Medicine, 42(11), 2409–2417.

11/05/2025

10/31/2025

454 team members (and one 3 year old 🙈😜) have successfully completed our annual skills fair this week! ✅

Tomorrow is the LAST day! Come on over and have a snozz-tastic time with us from 7a-10a. 🍭🍫🍬

10/27/2025

10/27/2025

Skills Fair Week has begun! Make sure you’re signed up for a Wonka-Licious time!

10/25/2025

Another hugely successful Critical Care Conference! So much appreciation to our conference planning committee, our speakers, vendors, and attendees! Special thanks to our wizard behind the curtain, Jeffery Corbett — we couldn’t do this each year without your support! Excited for 2026!!

10/23/2025

🍫✨ Oompa Loompa doo-ba-dee-doo… our Skills Fair fun is coming to YOU! ✨🍫

Breaking News: The Oompa Loompa has gone into labor! 😂
After a choco-late night of contractions, the Women’s Health team helped him push through and welcome a brand-new baby Wonka! 👶🍫
NICU stepped in for some postpartum sugar monitoring and golden care!

Because around here, every delivery deserves a golden ticket ✨