For all my EMS folk- we all know how loud it can be in the field- engines, A/C, exhaust fans, sirens, radios, people yelling- you know.. I use this with earbud(s) only. It is compact enough to carry on my person and it reduces ambient noise beyond any other I’ve tried to include the noise cancelling ears from another popular brand. When I know I’m running a breather or code I prelaunch the app and the EKO will connect within 5 seconds after turning it on. No more of the ‘ol “I can’t hear- can you?” I’ve only had it for a short time- so I’m uncertain how well it will hold up in the field. Cons- for prehospital folks it’s a bit pricey, it’s made of plastic, it’d be nice if they included a cap to protect the exposed junction which normally goes to the tubing/ears.