In this episode, Zach sits down with Dr. Ian Drennan and Dr. Sheldon Cheskes to dissect the newly released 2025 AHA and ILCOR resuscitation guidelines. They break down the evidence, controversies, and real-world implications for paramedic practice.

🔹 How guidelines are actually created
🔹 Mechanical CPR
🔹 Heads-Up CPR

🔹 IV vs IO Access

🔹 Medications
🔹 Defibrillation Science

🔹 Airway Management
🔹 Post Cardiac Arrest Care

In this episode, we explore the science, history, and frontline application of End-Tidal CO₂ (ETCO₂) — a tool that offers real-time insight into ventilation, perfusion, and metabolism. Danny and Rance from DnR explain how paramedics can use ETCO₂ to assess and guide care across multiple patient presentations.

Key Takeaways:

• ETCO₂ is the sixth vital sign — reflecting ventilation, perfusion, and metabolism in real time.

• Capnography vs. Oximetry: SpO₂ shows what was happening; ETCO₂ shows what's happening now.

• Waveform interpretation: Alpha and beta angles reveal underlying pathology like bronchospasm, obstruction, or air trapping.

• Clinical uses:

  • Tube confirmation: Real-time verification in 6 breaths or less.

  • CPR: Values <10 mmHg after 20 mins indicate poor prognosis.

  • Ventilation: Real-time feedback for rate and volume.

  • Head injuries: Maintain normocapnia; hyperventilate only during herniation.

  • Sepsis, trauma, PE, and DKA: Trending ETCO₂ helps identify metabolic and perfusion problems.

• Practical tips:

  • "Filter first, end-tidal to the sky."

  • Inline sensors outperform sidestream for accuracy.

  • End-tidal is not just for intubated patients — use it with nasal prongs for sedation and respiratory monitoring.

Delta Air Crash: Paramedics on the Frontline of a Mass Casualty Incident

In this gripping episode of Critical Levels, host Zach Cantor sits down with Ornge Critical Care paramedics Colin and Darren to discuss their response to the February 2025 Delta crash at Toronto's Pearson International Airport.

From the initial plume of smoke spotted mid-flight to interagency coordination on the ground, they share how training, adaptability, and teamwork guided decisions under extreme pressure.
Key Topics:
• First impressions from the air and immediate decision-making
• Mass casualty triage in an unpredictable environment
• The challenges of communication across multiple agencies
• The value of leadership, adaptability, and humility under stress
• Interdisciplinary and interagency debriefs: lessons learned
• Mental health, recovery, and supporting paramedics after major incidents

Takeaway:
Mass casualty incidents test every part of the emergency response system. Preparation, communication, and collaboration—not just within one service, but across all responders—make the difference.