Disaster Podcast

We delve into the recent surge of Influenza cases across large swaths of the United States in recent weeks. This year is shaping up to be a particularly difficult year for health care facilities and the patients who need them for treatment. Dr. Joe Holley joins us today to discuss what he’s seeing in the Memphis, Tennessee area and what the national flu outlook is.

The most common Influenza A strain right now is causing a surge in ER visits and hospital admissions across the U.S. right now. The dominant Influenza A strain for the 2025-2026 flu season is the A(H3N2) subclade K, a variant with notable mutations. The annual vaccine is moderately effective at preventing severe illness and hospitalization and the subclade K variant responds well to antivirals such as Tamiflu.

The episode was co-hosted by Sam Bradley and Jamie Davis.

Scroll down for Podcast Discussion Summary

Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well.

Podcast Discussion Summary

Flu Trends and Vaccination Impact

Joe and Jamie discussed the recent surge in flu cases, particularly affecting unvaccinated individuals and those with underlying health conditions. Jamie shared his experience of being admitted to the ER with influenza A and noted that vaccinated individuals were more likely to be discharged. Joe confirmed that national trends showed higher hospitalization rates and deaths among the unvaccinated, elderly, and those with other medical issues.

Flu Awareness for Healthcare

Jamie shared his severe flu experience, which included a high fever, chills, and muscle cramps, leading him to seek emergency care. He emphasized the importance of flu awareness for healthcare professionals, noting the recent increase in flu-related deaths and pediatric deaths reported by the CDC.

Healthcare Virus Transmission Prevention

Jamie and Joe discussed protective measures for healthcare providers against virus transmission, emphasizing hand hygiene, respiratory protection, and avoiding confined spaces with sick individuals. Joe highlighted the risk of virus spread in confined environments like airplanes, while Jamie shared personal experiences and encouraged listeners to take transmission prevention seriously, noting its impact on their community.

Post-COVID Brain Fog Symptoms

Jamie described experiencing “brain fog” after recovering from COVID-19, which made mental tasks difficult and required significant mental effort. Joe explained that this could be due to increased inflammatory markers and the body’s energy expenditure in fighting the infection. Sam noted that their household member who had not been vaccinated experienced different symptoms, and both Sam and their household member took about two weeks to regain their energy levels.

Influenza Symptoms and Management

Joe explained that vaccination can reduce the severity of symptoms, and both Jamie and Sam experienced typical symptoms of influenza A, with Jamie noting the importance of IV fluids in managing his symptoms. Sam described severe gastrointestinal symptoms, while Jamie mentioned being prescribed Zofran despite not experiencing nausea. Joe elaborated on how dehydration and inflammatory mediators contribute to symptoms, and rehydration can help alleviate them.

Winter Virus and Flu Updates

Jamie shared his experience of being delayed for release from the hospital due to low blood pressure, which was unusual for him. The medical team tried various methods to increase his blood pressure, including making him angry and having him walk around. Joe explained that while having the flu is unpleasant, it leads to the development of protective antibodies. Sam noted that the flu often overshadows other winter viruses, and Joe confirmed they are still seeing a variety of other respiratory infections.

Early Flu Treatment and Testing

Joe and Sam discussed the importance of seeking medical attention and testing for flu symptoms, with Joe recommending early treatment with antiviral drugs like Tamiflu, which are most effective within the first 48 hours of symptoms. Sam acknowledged that healthcare professionals might be reluctant to visit doctors when they need to, possibly due to a false sense of invincibility. Jamie emphasized the significance of early testing and treatment for flu, aligning with Joe’s advice.

Influenza Testing and Treatment Discussion

The group discussed influenza prevention and treatment, with Joe emphasizing the importance of early diagnosis and medication, particularly given the availability of over-the-counter rapid flu tests. Jamie noted that the COVID-19 pandemic had increased access to home testing, which Sam and Joe hadn’t previously considered. They agreed that while many people might choose to tough it out, getting tested early could be beneficial.

Flu Prevention and Training Updates

The team discussed the flu, including its incubation period and how it spreads. Joe explained that people are most infectious when symptoms start, as their viral load is high. Jamie mentioned that the team had been affected by the flu in various ways. Joe also shared that Paragon is working on a new cadaveric-based simulator for pericardial tamponade training. The team encouraged listeners to stay safe and follow guidelines to prevent the spread of the flu.

The group discussed the role of specialized training, with Jamie highlighting the sponsorship of the Disaster Podcast by Paragon Medical Education Group.

Catch the full episode using the player above or on your favorite podcast platform, and don’t forget to subscribe to the Disaster Podcast for weekly insights from leaders in disaster response and research!

We gather our podcast regulars for a look at the past year on the show with our 2025 Disaster Podcast year in review. Dr. Joe Holley joined co-hosts Sam Bradley and Jamie Davis for this episode. Kyle Nelson, Becky DePodwin, and Dan DePodwin sent in their top episode picks by email.

Joe Holley kicks off the look back at last year with a vote for the clinical topics, especially the recent 5-episode run on head-up CPR during sudden cardiac arrest. We assembled a special page for the head up CPR topic with all 5 episodes listed.

Joe also discussed the importance of understanding how research works and not to get caught up in a single social media post on a novel subject without really understanding the context amidst other research. His final choice was the look at K9 and USAR dog training with Kimberly Holley. Kimberly has extensive training alongside her two trained USAR dogs and the third dog she has in training.

Kyle talked about the episode with the Combat Midwife, Jessica Arno. This was an in-depth look at maternal and pediatric disaster care. In addition, Stump Dan the weatherman was another favorite episode as host Sam Bradley used the internet to come up with some novel weather terms and try to stump our own Dan DePodwin. These episodes are an annual favorite as Dan has an amazing understanding of weather, especially winter weather.

Investigating airline disasters with Edward Colson of Ready Northwest was one of Becky DePodwin’s favorites as we delved into aviation industry disaster planning. She also put in her vote for the Stump the weatherman episode linked above.

Jamie added the annual look at the Winter X-Games in Aspen. Our own Kyle Nelson worked as Planning Section Chief for the incident management team before and during the event this past year and shared some of the challenges they faced making such an event as safe as possible.

We covered many other excellent topics this past year. If you have a different favorite from the ones listed in this episode retrospective, leave your answer in the comments below.

Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well.



Catch the full episode using the player above or on your favorite podcast platform, and don’t forget to subscribe to the Disaster Podcast for weekly insights from leaders in disaster response and research!

Kurt Bramer from Advanced CPR Solutions comes back for a final look at Head-Up CPR as we pull all the pieces from the earlier four episodes together. Dr. Joe Holley is back to bring in the latest research into the process as well. We will tie all this back to the global health disaster that is sudden cardiac arrest.

Recent research from across the emergency medical community has pointed to impressive improvements in both return of spontaneous circulation (ROSC) as well as survival to discharge and neurologically intact survival when compared to conventional supine CPR performance. We’ll have links below to some of those studies and papers.

Research Bibliography for Head-Up CPR Studies

The episode is co-hosted again by our regular hosts, Sam Bradley and Jamie Davis.

Elevated CPR Series Episode One

Elevated CPR Series Episode Two

Elevated CPR Series Episode Three

Elevated CPR Series Episode Four

CARES Registry for Cardiac Arrest Stats

Follow up on more of these segments as we continue to look at the current research trends in future episodes and what is on the horizon for the future.

The episode was co-hosted by Sam Bradley and Jamie Davis.

Scroll down for Podcast Discussion Summary

Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well.

Podcast Discussion Summary

Head-Up CPR Research Update

Jamie and Sam discussed the upcoming podcast episode, which will focus on wrapping up the last four episodes about head-up CPR and recent research. They mentioned the challenges of implementing new approaches in rural systems with volunteer staff. Sam noted that Dr. Joe and Kurt Bramer have been working on presenting the information in a way that can be applied responsibly.

Joe briefly mentioned that SENA teams were activated to assist with floods in Seattle. The main focus of the episode will be on the latest data on head-up CPR, including improved physiology, survival rates, and neurological function, particularly for non-shockable rhythms like asystole.

Advantages of Head-Up CPR Studies

Sam, Kurt, and Joe discussed the significance of two seminal studies on head-up CPR. The 2016 preclinical animal study showed significant improvement in perfusion when compared to standard CPR, with a synergistic effect when using additional devices like the ITD and suction cup. The 2022 independent registry analysis demonstrated that head-up CPR resulted in a five times greater likelihood of neurologically intact survival compared to conventional CPR, even up to 20 minutes post-cardiac arrest.

Joe explained that the bundled care approach for cardiac arrest patients involves multiple components, including appropriate ventilation, high-quality CPR, and post-resuscitation care, all of which contribute to improved outcomes.

Bystander CPR System Implementation

The discussion focused on the importance of proper implementation of bystander CPR, AEDs, and advanced techniques like impedance threshold devices and suction cup CPR to improve patient outcomes, particularly neurologic ones. Kurt emphasized the need for a system-wide approach, from first responders to hospital care, highlighting successful partnerships like Louisville’s, where continuity of care is prioritized.

Jamie inquired about best practices for implementing this system-wide approach, to which Kurt responded with examples from different regions, noting that while ideal partnerships exist, proactive agencies can still achieve good outcomes even with less supportive hospitals.

Cardiac Arrest Resuscitation Bundle Implementation

The team discussed the importance of addressing multiple aspects of cardiac arrest resuscitation simultaneously, as highlighted by Joe, who emphasized that successful outcomes require implementing all elements of the care bundle equally. Jamie inquired about training approaches, to which Joe responded that effective training involves both initial instruction and ongoing feedback through quality improvement processes, stressing that successful resuscitations require adherence to the entire bundle rather than just some components.

Prioritizing Tasks in Resuscitation

Joe and Kurt discussed the importance of prioritizing tasks during resuscitation, emphasizing the need to focus on the overall process rather than individual steps. They highlighted the benefits of the Head-Up CPR model, which organizes priorities and reduces chaos during medical emergencies. Kurt explained that this method allows for more efficient and coordinated delivery of therapies, leading to better patient outcomes.

Head-Up CPR Survival Benefits

The group discussed two significant studies on CPR techniques. Kurt presented findings from a 2023 preclinical study showing that early administration of head-up CPR resulted in a 40% 24-hour survival rate compared to 9% for delayed conventional CPR.

Joe highlighted an observational study from 2024 showing that head-up CPR improved survival rates for non-shockable rhythms from 2.8% to 7.6%, representing a nearly 3-fold improvement. Both studies suggested that head-up CPR could significantly enhance survival chances, particularly when administered early.

Non-Perfusible Rhythm Blood Flow Method

The group discussed a new methodology for perfusing patients with non-perfusible rhythms, which allows for continued blood flow and preserves neurological status. Joe explained that this could open up windows for interventions like ECMO or cardiac catheterization while CPR is underway.

Kurt shared anecdotal evidence from agencies that have gained confidence in staying longer during arrests, leading to increased rates of ROSC in non-shockable rhythms. The group also touched on the importance of proper ventilation during CPR, with Joe highlighting the lack of focus on this aspect in many clinical trials.

Head-Up CPR Survival Benefits

Joe explained the concept of pressure-volume loops in CPR, demonstrating that head-up CPR generates greater blood flow and pressures compared to standard CPR. Kurt presented data from two studies comparing outcomes between CARES and head-up CPR data, showing improved survival rates for head-up CPR patients over one and five-year periods. The research suggests that head-up CPR may lead to better patient outcomes, though these findings were not included in the 2025 American Heart Association guidelines.

Cardiac Arrest Economic Impact Discussion

The group discussed the economic impact of cardiac arrests, with Kurt noting that the total cost per person in the US is approximately $4,000 annually, highlighting the need for improved resuscitation techniques. Jamie emphasized the importance of community contributions from survivors, while Joe provided recommendations for enhancing CPR quality, including the use of the Lucas 3.1 device with its enhanced lift feature and avoiding overly tight cervical collars during CPR to maintain blood flow.

Improving Sudden Cardiac Arrest Response

The meeting focused on sudden cardiac arrest, emphasizing its global impact as a leading cause of death. Kurt and Joe discussed the need for first response agencies and emergency managers to explore research and improve care delivery to enhance patient survivability. Joe highlighted the importance of understanding the physiology of cardiac arrest and considering new approaches, as current CPR methods have not changed in 50 years.

Jamie suggested applying disaster management strategies to sudden cardiac arrest to improve outcomes. Joe mentioned upcoming procedural cadaver labs and ongoing work on superglottic studies and new airway management tools. Kurt provided contact information for further discussions and was invited to return for future updates on research.

Podcast Series Conclusion and Future Plans

The group discussed the conclusion of a podcast series on medical topics, with Kurt expressing gratitude for the opportunity to share his message and Jamie inviting him back for future episodes. They agreed to continue the conversation on social media and the Disaster Podcast website, with Kurt planning to draft questions for potential CEU credits.

The group the role of specialized training, with Jamie highlighting the sponsorship of the Disaster Podcast by Paragon Medical Education Group.

Catch the full episode using the player above or on your favorite podcast platform, and don’t forget to subscribe to the Disaster Podcast for weekly insights from leaders in disaster response and research!

Kurt Bramer from Advanced CPR Solutions returns again this week to continue the series on Head-Up CPR and other promising sudden cardiac arrest treatments. There are three previous episodes in this series.

Elevated CPR Series Episode One

Elevated CPR Series Episode Two

Elevated CPR Series Episode Three

Elevated CPR Series Episode Five

After the severe weather update from disaster meteorologist Dan DePodwin, the Disaster Podcast team focuses on the science and physiology of Head-Up CPR. They ask why this approach provides for better protection of neurological function during a cardiac arrest. Dr. Joe Holley does an excellent job of describing the specific concepts of pressure gradients in blood flow to and from the heart during CPR in various patient positions.

Kurt outlines what he calls the Four Rules of Head-Up CPR that are essential components for successful resuscitation during cardiac arrest treatment. These rules come from Dr. Joanna Moore’s Editorial The Do’s and Don’ts of Head Up CPR:

1) Use of Suction Cup CPR and an ITD

2) A Priming Period is Needed

3) Cannot Lift the Patient Too High

4) You Cannot Lift the Patient Too Quickly

CARES Registry for Cardiac Arrest Stats

Follow up on more of these segments as we continue to look at the current research trends in future episodes and what is on the horizon for the future.

The episode was co-hosted by Sam Bradley and Jamie Davis.

Scroll down for Podcast Discussion Summary

Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well.

Podcast Discussion Summary

Episode Opening segment and Weather update

The meeting began with a discussion about travel weather for the country and record cold in many parts of the upper midwest and northeast with Dan DePodwin.

The group then transitioned to their main topic, the physiology of CPR, with Dr. Joe Holley focusing our attention on the specific anatomy and process inside the body during CPR.

Head-Up CPR Techniques Discussed

Kurt and Joe discussed the importance of adhering to the “four rules” of head-up CPR, which were derived from a published editorial by Dr. Moore. They emphasized that studies showing no improved outcomes often violate these rules, highlighting the significance of proper technique. Jamie Davis, the host of the Disaster Podcast, introduced the episode, which would focus on the science and physiology of elevated CPR, while Sam and Dan briefly discussed the early winter weather conditions across the United States.

Head-Up CPR Research Advances

The discussion focused on head-up CPR, a novel research advancement in resuscitation aimed at improving neurologic survival. Kurt explained its origins, highlighting a case study involving a ski hill cardiac arrest patient who survived due to an elevated head position, which was later recognized as a critical factor.

The conversation also touched on a study conducted in South Korea, where researchers developed a modified EMS stretcher to accommodate patients in high-rise buildings with small elevators, leading to the question of the optimal CPR position. Initial findings from animal studies suggested that a head-up position could reduce intracranial pressure, potentially improving outcomes during CPR.

CPR Physiology and Blood Flow

Joe explained the physiology of CPR, focusing on how differences in pressure inside the body create blood flow. He described how chest compressions increase intrathoracic pressure, pushing blood towards the brain and other areas of lower pressure. He emphasized that over-ventilation and incomplete chest recoil can be detrimental during CPR, as they prevent blood from flowing back into the heart. He also noted that patients who exhibit “guppy breathing” during resuscitation have a better chance of successful resuscitation.

CPR Vacuum Technology and Physiology

Joe explained the physiology of blood flow during CPR, focusing on the importance of preload and the manipulation of pressure differences between the thoracic cavity and the brain. He described how the ITD16 device creates a vacuum in the chest to enhance blood flow to the brain and reduce intracranial pressure. Joe also discussed the concept of “head-up CPR,” which combines enhanced vacuum with gravity assistance to improve blood flow and neuroprotective outcomes.

Head-Up CPR Techniques and Safety

Sam and Kurt discussed the importance of using proper equipment and techniques for head-up CPR, as outlined by Dr. Joanna Moore’s “four rules.” Kurt emphasized that suction cup CPR in conjunction with an ITD or rescue pod is crucial for effective and safe head-up CPR.

He also stressed the need for a priming period, avoiding excessive head elevation, and slow head-up positioning to prevent blood from draining from the head faster than CPR can pump it back in. Kurt noted that studies claiming head-up CPR doesn’t work often violate these rules, highlighting the significance of adhering to the correct procedures.

Head-Up CPR: A Novel Approach

The team discussed the importance of proper technique in head-up CPR, emphasizing that it requires a bundled care approach with specific parameters to be effective. Joe and Kurt shared a case study of a retired fire chief who successfully underwent head-up CPR, highlighting the potential benefits of this novel approach. The discussion also touched on the concept of using a combination of therapies in resuscitation, similar to the drug cocktail approach used in treating HIV.

Success Stories in Advanced CPR

The meeting focused on sharing and discussing remarkable cases of successful CPR, particularly highlighting the concept of “head-up” CPR, which has shown improved outcomes. Kurt and Joe shared several stories of patients who experienced significant neurologic recoveries after cardiac arrests, with survival rates and recovery rates significantly higher than national averages. The discussion emphasized the potential of advanced CPR techniques to improve survival and neurologic outcomes, with Joe noting that two of his services have seen similar success rates.

The group the role of specialized training, with Jamie highlighting the sponsorship of the Disaster Podcast by Paragon Medical Education Group.

Catch the full episode using the player above or on your favorite podcast platform, and don’t forget to subscribe to the Disaster Podcast for weekly insights from leaders in disaster response and research!

We are joined by Kurt Bramer from Advanced CPR Solutions again this week to continue the series on Head-Up CPR and other promising sudden cardiac arrest treatments. He and Dr. Joe Holley kicked off the discussion in two previous episodes.

Elevated CPR Series Episode One

Elevated CPR Series Episode Two

Elevated CPR Series Episode Four

Elevated CPR Series Episode Five

We open this week’s episode with a holiday severe weather update from our disaster meteorologist, Dan DePodwin. He reports on several storm systems that will impact Thanksgiving holiday travel across the eastern half of the country.

Following that update, we kick off episode 3 of our Head-Up CPR series with a look at the long history of the evolutionary changes to cardiac arrest treatment. Kurt Bramer from Advanced CPR Solutions leads off with a response to some comments to the first two episodes in this series. A few listeners worried that we might sound like we were criticizing the individual responders on cardiac arrest calls over the low survival rates for the condition.

The team made a joint statement that no criticism of providers in the field was intended. We all are providers ourselves and are merely commenting on the results that everyone has been getting in response to treating cardiac arrest. Some systems do better with resource management than others, but even those areas fail to save even a simple majority of their cardiac arrest patients.

CARES Registry for Cardiac Arrest Stats

Follow up on more of these segments as we continue to look at the current research trends in future episodes and what is on the horizon for the future.

The episode was co-hosted by Sam Bradley and Jamie Davis.

Scroll down for Podcast Discussion Summary

Thank you as always to Paragon Medical Education Group for their long-term support of the Disaster Podcast. Dr. Joe Holley and the team at Paragon continue to provide excellent and customized disaster response training to jurisdictions around the U.S. and internationally as well.

Podcast Discussion Summary

CPR Challenges and Future Improvements

The meeting began with a discussion about travel weather for the Thanksgiving weekend, with Dan DePodwin warning of widespread lake effect snow in the eastern United States and a potential ground blizzard in the Dakotas and Minnesota.

The group then transitioned to their main topic, CPR, where Joe clarified that their previous discussion about CPR’s limitations was not meant to criticize CPR providers, but rather to highlight the challenges and lack of progress in the field over the past 50 years. They planned to explore potential improvements to CPR in future episodes.

Advancements in CPR Techniques

Kurt Bramer, with 40 years of experience in EMS and emergency management, discussed the history of CPR, highlighting its evolution from mouth-to-mouth resuscitation to modern techniques. He emphasized the need for better tools and more effective methods for emergency responders, as current practices are often based on outdated or insufficiently tested techniques.

The group acknowledged that while responders are doing their best with limited tools, recent research may lead to positive changes in CPR practices. They also touched on the introduction of high-performance CPR in the 2010s, which aimed to maximize the effectiveness of current technologies and minimize detrimental pauses during resuscitation efforts.

Mechanical CPR Guidelines Review

The discussion focused on the American Heart Association’s recent guidelines regarding mechanical CPR, which recommend against routine use but allow for exceptions like transport scenarios. Kurt and Joe highlighted that the guidelines lump together different types of mechanical compressors, ignoring their unique physiological effects and training limitations.

They emphasized that current research primarily focuses on patient survival as an endpoint, which may not fully capture the benefits of mechanical CPR, such as improved blood flow and reduced pauses during resuscitation. The conversation also touched on the importance of considering neurological outcomes beyond mere survival and the need for better training on integrating mechanical devices into overall cardiac arrest management.

Bundle Care Approach in Resuscitation

The group discussed the bundle of care approach in resuscitation, focusing on the use of multiple therapies simultaneously to improve patient outcomes. Kurt and Joe highlighted the success of the ITD (Impedance Threshold Device) when used with high-quality CPR, leading to a 50% increase in one-year survival. They also noted that only a small percentage of resuscitation guidelines are supported by randomized control trials, emphasizing the challenges in interpreting research data.

The group discussed the importance of disaster preparedness and the role of specialized training, with Jamie highlighting the sponsorship of the Disaster Podcast by Paragon Medical Education Group.

Catch the full episode using the player above or on your favorite podcast platform, and don’t forget to subscribe to the Disaster Podcast for weekly insights from leaders in disaster response and research!