Heavy Lies the Helmet

Heavy Lies the Helmet

"Heavy lies the crown" is a common misquote of "uneasy lies the head that wears a crown" from Shakespeare's Henry IV, Part 2. It refers to the responsibility and insecurity of governing an entire kingdom. Likewise, "heavy lies the helmet" refers to the responsibility we face as critical care transport providers working in an autonomous and often unpredictable environment. Our minds are eased with education that better prepares us for any situation that we may encounter. That is exactly what Heavy Lies the Helmet provides. Founded by two brothers, Heavy Lies the Helmet is comprised of industry leaders working in the fields of pre-hospital and inter-hospital critical care and emergency services. We are an accredited podcast, blog, and conference that openly discusses the world of resuscitation and aviation. We highlight caring for critically ill and injured patients in addition to the controversies surrounding their management. Though tailored to the transport environment, our information is applicable to any discipline working in an emergency and/or intensive care setting. We utilize the most recent evidence to provide applicable and accurate education that can assist in improving individual clinical practice and overall program operations. We offer continuing education units to any listener and/or reader interested in obtaining credit for their progressive learning experience. Please visit heavyliesthehelmet.com/ce for more information.


May 25, 2023 61 mins

Vascular emergencies refer to any time-sensitive condition where perfusion is prevented secondary to bleeding or occlusion of a vessel. These can include, but is not limited to, the superior mesenteric artery (SMA) and aorta. And depending on the severity of the aneurysm or embolism/thrombus, downstream ischemia can significantly impact a patient's quality of life. How do we identify these conditions? When are they classified as a ...

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Reviewing case studies with trusted colleagues can be extremely beneficial. Not only does it provide a moment of reflection on actions taken, but it also provides different approaches that may be applicable to future scenarios.

Occasionally we like to challenge each other, and this episode is no exception. Tune in as Amanda, Dan, and Mike present three real case studies and see if they would approach the same patient differently. W...

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Have you ever handed off to an ER doctor, and you felt they were displeased with your care? Have you ever received an order from an ER doctor, and you didn't quite understand why? In this podcast episode, we continue our "10 Things" series with a focus on the emergency department. Our very own Dr. Amanda Humphries, Emergency Physician and Assistant Professor of Emergency Medicine and Emergency Medical Services,  leads the discussio...

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March 5, 2023 37 mins

Myocardial infarctions can present in a variety of ways depending on vessel involvement, timing of pathology, and interpretation of diagnostics (e.g., 12-lead EKG). Unfortunately, not every patient with a myocardial infarction will fit STEMI criteria's paradigm, which has lead to the adoption of a new term: OMI (Occlusion Myocardial Infarction). In this podcast episode, we are joined by our very own Nick Zuber to discuss his recent...

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February 6, 2023 52 mins

No matter what level of scope, management of medical and traumatic cardiac arrests is the focus of many clinicians. But what happens after return of spontaneous circulation (ROSC) is achieved? Many do not appreciate the fact that the likeliness of re-arrest is high. How can we avoid return of spontaneous arrest by appropriately treating the patient during the peri-arrest phase and subsequently improving quality of life? Tune in to ...

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The medical industry puts great emphasis on formal education via university and other training programs. Due to financial incentive, these institutions often discourage independent learning despite it usually having a greater impact on patient care quality. For example, paramedics are often non-degree holders, yet they effectively practice medicine on a daily basis as a result of learning via unconventional methods (e.g., podcasts)...

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December 8, 2022 36 mins

Whether it's antibiotic-resistant "super bugs" or administration prior to acquiring blood cultures, empirical use of antibiotics is controversial. Should we be administering antibiotics in the prehospital environment for open long bone fractures and/or sepsis? When are antibiotics truly indicated? And is that more important than the timing of the antibiotic itself? This podcast is not only "Antibiotics 101", but we also address the...

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November 22, 2022 55 mins

It's not clinical. It's not non-clinical, really. Celebrating our 100th full podcast episode, Bryan and Mike sit down in a Mystery Science Theater 3000 format and make fun of our 1st episodes ever. If you're looking for some light-hearted entertainment including a reflection of how far the platform as come, this is the podcast for you.

And one last thing...


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Based on the Crash and Learn 2022 special feature presentation, we sit down with Jonathan Godfrey and Chris Stevenson to discuss the EMS helicopter crash that had a dramatic effect on both of their lives. Jonathan is the sole survivor of a 3-person crew, and Chris was part of his leadership team at the time of the incident. We carefully examine both perspectives and how the rest of us can learn from their experiences.

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October 13, 2022 44 mins

Gastrointestinal hemorrhages can present in a variety of ways from a variety of sources. Bleeding esophageal varices, in particular, can be life-threatening. How do we manage these patients? When is it appropriate to establish an advanced airway? Are gastrointestinal tubes contraindicated even though the patient is vomiting? And what do we do when an esophageal tamponade device is indicated or already in place? Tune in to another p...

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September 23, 2022 74 mins

Whether it's radio or bedside reporting, communication is a requirement of safely handing off patients. How do we build confidence in our ability to communicate about our patients? How do we develop qualities such as professionalism, accuracy, and conciseness that are essential to our reports? And if we experience interpersonal conflict, how do we resolve it? Tune in to this podcast episode where we discuss how to effectively commu...

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Having an appropriate mindset is crucial when it comes to airway management, particularly in a prehospital and/or emergency setting. Whether it's team dynamics or the tools at our disposal, we need to have a different outlook when it comes to addressing the A in ABC's.

If you are looking for a comprehensive guide on how to RSI, this is not the episode for you. This is simply a table discussion about appropriate perspective.

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August 8, 2022 62 mins

Traumatic Brain Injury (TBI) is always in the back of our minds when treating polytrauma patients. Unfortunately, the evidence has a controversial history. More and more, we are reminded of how a basic approach is much more important than other therapies that have little evidence to support their effectiveness. In fact, some may even cause harm.

Tune in to a podcast where we debunk these common TBI myths. Also, this is the debut ep...

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Heat illness is prevalent around this time of year. And compared to hypothermia, hyperthermia has a lower threshold for danger. From heat cramps to heat stroke, clinicians need to know how to identify and treat each stage appropriately. But what contributes to severe heat illness? How do we treat each stage of illness? And how much time do we hav...

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It's no secret that we as emergency and critical care professionals are expected to perform highly in high pressure situations. Unfortunately, none of us are immune to limited cognitive capacity, task saturation/fixation, time pressure, negative team dynamics, and poor communication. How can we mitigate these variables, so that we can continue to effectively operate in our respective fields? Join us for an insightful podcast episod...

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What should you carry in your flight suit as an American-based HEMS provider? In our opinion, no one can definitively tell you that. But we can attempt to share some ideas based on our personal experiences and training. In this vodcast, Mike shares what he currently carries in his flight suit; from survival gear to medical equipment.

Watch the vodcast on our YouTube channel at /heavyliesthehelmet.

Brands include:

One Shear

ER Life


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Mores lies! But this time, we focus on empirical use of spinal immobilization devices and the harm associated with them. The dogma surrounding this topic is staggering, to say the least. From EMS agencies to Level 1 tertiary centers, cervical collars and long spine boards (LSB) remain a "standard" predicated on a lack of evidence. What evidence DO we have regarding spinal immobilization? And how should we restrict spinal movement o...

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April 15, 2022 41 mins
Diabetic Ketoacidosis (DKA) is a common metabolic disorder, particularly in the pediatric population. If treated inappropriately, these patients can quickly decompensate to the point of hypovolemic shock, acute respiratory failure, and even cerebral herniation. What are the physiological differences behind DKA verses HHS (Hyperglycemic Hyperosmolar Syndrome)? What are some simple methods to identify DKA in the field? How do we effe...

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March 30, 2022 53 mins

There are a lot of "lies"/misunderstandings surrounding appropriate use of paralytics AKA neuromuscular blocking agents (NMBAs). When are these medications truly indicated? How do we appropriately administer them? How do we accurately monitor these patients? And how do we reverse the effects of NMBAs? Tune in to another pharmacologically driven podcast where we draft our EM pharmacist friend, Chase Turner, to discuss.

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March 8, 2022 59 mins

The clotting cascade, particularly in the context of anti-coagulation reversal can be complex to understand. Unfortunately, many of our patients are on anti-coagulation agents that require reversal in the presence of life-threatening hemorrhage. How do we choose the most appropriate agent based on which step of the coagulation cascade that it antagonizes? And when is it time to pull the trigger on doing so? In this podcast episode,...

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