You’re in the back of a rig. The lights are flickering, the patient is gray, and suddenly every textbook answer you memorized in EMT school evaporates. It’s just you, your partner, and a situation that feels like it’s spiraling out of orbit. This is where the EMS 20/20 podcast lives. It doesn't live in the sterile, "perfect world" scenarios where every patient has a clear medical history and follows the algorithm. It lives in the mess.
Spencer Oliver and Chris Finston, the guys behind the mics, aren’t just talking heads. They’re experienced flight paramedics who have seen the inside of more trauma bays than they’d probably like to count. What they’ve built isn’t just another medical lecture series. It’s a post-mortem on real-life calls that went sideways, stayed on track, or got weird. They basically take a listener-submitted call, strip it down to the bone, and look at it through the lens of "Hindsight is 20/20."
What the EMS 20/20 Podcast Actually Gets Right About Medicine
Most medical education is boring. Let's be real. Reading a 40-page chapter on cardiology is a great way to fall asleep, but hearing a story about a medic who misread an ECG because the patient’s dog was biting their ankle? That sticks. The EMS 20/20 podcast uses narrative to teach. Humans are wired for stories, not bullet points. Spencer and Chris understand that the technical skills—intubation, IV starts, drug dosages—are only half the battle. The other half is the "soft" stuff: crew resource management (CRM), communication, and managing your own adrenaline.
Take their frequent discussions on "confirmation bias." It’s a fancy term for when you decide what’s wrong with a patient before you even touch them. We’ve all done it. You hear "shortness of breath" over the radio and your brain screams "asthma." Then you get there and it’s actually a pulmonary embolism. The show beats this drum constantly because it’s the mistake that kills.
The Dynamic Between Spencer and Chris
Honestly, the show works because these two actually like each other. Chris is often the clinical powerhouse, diving deep into the pathophysiology of why a certain drug works or why a specific symptom is a "red flag." Spencer brings a massive amount of emotional intelligence to the table. He focuses on the psychology of the provider. Why did the medic feel rushed? Why didn't they speak up when they saw their partner making a mistake?
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They aren't here to roast the people who send in calls. That’s the most important part. EMS culture can be toxic. There’s a lot of "eating our young" and acting like we’ve never made a mistake. EMS 20/20 podcast flips that. They create a "just culture" where mistakes are viewed as systemic failures or common cognitive traps rather than just being a "bad medic." It’s refreshing. It’s also probably why they have such a massive, loyal following.
Breaking Down the Clinical Deep Dives
When you listen to an episode, you’re going to get a mix of "The Call" and "The Breakdown."
Usually, Spencer tells the story. He’s a good storyteller. He sets the scene, describes the smells, the sounds, and the specific brand of chaos that only occurs at 3:00 AM in a cramped apartment. Chris listens along, often hearing the details for the first time just like the audience. They stop. They pivot. They ask, "What would you do here?"
- Differential Diagnosis: They don't just look for the right answer; they look for the "must-nots." What must we rule out so this person doesn't die in the next ten minutes?
- The "Pit Crew" Approach: They talk a lot about how to run a scene physically. Where are you standing? Who is holding the monitor? It sounds basic, but it’s where calls usually fall apart.
- Pathophysiology simplified: They explain complex things—like the V/Q mismatch or the R-on-T phenomenon—in ways that don't require a PhD to understand.
One thing that sets the EMS 20/20 podcast apart is their focus on the "gray areas." In school, the patient has either a high blood pressure or a low one. In the real world, they have a "weird" one. They have symptoms that contradict each other. Spencer and Chris embrace that ambiguity. They admit when a call is just plain hard and there might not have been a perfect outcome regardless of what the medic did.
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Why Experience Alone Isn't Enough
There’s this old saying in EMS that some people have ten years of experience, while others have one year of experience ten times. The difference is reflection. If you don't look back at your calls and analyze what happened, you aren't actually getting better. You’re just getting older.
The EMS 20/20 podcast is essentially a masterclass in reflection. By listening to them deconstruct someone else's call, you start deconstructing your own. You start noticing your own biases. You start realizing that maybe you do tend to ignore the vitals when the patient is being "difficult." It’s a subtle shift in mindset that turns a technician into a clinician.
Beyond the Patient: The Mental Health Aspect
They don't shy away from the dark stuff either. EMS is heavy. The show often touches on the burnout, the PTSD, and the sheer exhaustion of the job. But they do it without being "cringey." It’s not a "hero" narrative. It’s just two guys talking about how hard it is to see what we see and then go home and try to eat dinner with our families. This honesty builds a bridge with the audience. You feel like you’re sitting in the bay after a shift, just decompressing.
Common Misconceptions About the Show
Some people think it’s only for paramedics. It’s not. If you’re an EMT, an AEMT, a nurse, or even a doctor, there is value here. The principles of communication and decision-making are universal in medicine.
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Others think it’s just about "Monday morning quarterbacking." If you actually listen, it’s the opposite. They often defend the provider’s actions, explaining why a choice made sense in the moment even if it turned out to be wrong later. They understand the "fog of war."
How to Get the Most Out of EMS 20/20
Don't just listen to it like a true-crime podcast while you’re doing dishes. Well, you can, but you won't learn as much.
- Pause the episode. When Spencer asks, "What do you think is going on?" or "What would you do next?"—actually answer. Say it out loud. Commit to a treatment plan.
- Take the "One Thing" rule. Every episode, try to find one specific clinical pearl or one communication tip to use on your next shift. Just one.
- Share the episodes. Talk about them with your partner. Use them as a jumping-off point for your own debriefs. It makes the "awkward" conversation about a bad call a lot easier when you can say, "Hey, I heard this on EMS 20/20, and it reminded me of that call we had..."
Actionable Steps for the Aspiring Clinician
If you want to move beyond just "following protocols" and start actually practicing medicine, here is what you need to do starting today.
- Review Your Own Calls: After every "hot" call, take five minutes. Write down what went well and what felt clunky. Don't worry about the clinical outcome yet; focus on the process.
- Study the "Why": Next time you give a medication, don't just know the dose. Know exactly what it’s doing to the receptors in the body. If you can’t explain it to a five-year-old, you don't know it well enough.
- Practice "Closed-Loop" Communication: Next shift, try it. "I'm going to give 5mg of Midazolam." "Copy, 5mg of Midazolam being given." It feels robotic at first, but it prevents 90% of medication errors.
- Listen to the back catalog: Start from the beginning of the EMS 20/20 podcast. The early episodes lay the groundwork for their "Rules of the Rig" that they reference later on.
- Submit a call: If you have a call that haunts you or one that you're particularly proud of, send it in. The process of writing it out for them is a form of education in itself.
The reality of emergency medicine is that we are all just practicing. Nobody has it all figured out. The moment you think you’re the smartest person in the room is the moment you become dangerous. Shows like this keep us humble, keep us sharp, and remind us that we’re all in this together, trying to do right by the person on the stretcher.