Pre-Hospital Care

In this episode, Alec Wilding is joined by Nikki Hewitt, a clinician who has been among the first Paramedics in the United Kingdom to deliver pre-hospital ECMO as part of London's Air Ambulance (LAA), Endovascular Cardiac Arrest Team, known as ECAT. This represents one of the most significant steps forward in resuscitation science within the pre-hospital environment, and Nikki has been at the centre of that evolution.During the conversation, Nikki guides us through the evidence base underpinning ECPR, exploring what we currently know, what remains uncertain, and how ongoing research continues to shape clinical decision-making. She also takes us inside the operational structure of the ECAT model, how the team was established, what it takes to deliver ECMO in the field, and the training, skill sets, and logistics required to make it viable outside the hospital walls.Nikki also shares her perspective on where ECPR is heading: The challenges, the opportunities, and what the future of advanced pre-hospital cardiac arrest care may look like as technology, capability, and evidence continue to advance. It is a fascinating area of practice, and Nikki brings frontline insight, experience, and clarity to a topic that is reshaping the conversation around survivability in cardiac arrest.This Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In this episode, Alec Wilding is joined by Nikki Hewitt, a clinician who has been among the first Paramedics in the United Kingdom to deliver pre-hospital ECMO as part of London's Air Ambulance (LAA), Endovascular Cardiac Arrest Team, known as ECAT. This represents one of the most significant steps forward in resuscitation science within the pre-hospital environment, and Nikki has been at the centre of that evolution. During the conversation, Nikki guides us through the evidence base underpinning ECPR, exploring what we currently know, what remains uncertain, and how ongoing research continues to shape clinical decision-making. She also takes us inside the operational structure of the ECAT model, how the team was established, what it takes to deliver ECMO in the field, and the training, skill sets, and logistics required to make it viable outside the hospital walls. Nikki also shares her perspective on where ECPR is heading: The challenges, the opportunities, and what the future of advanced pre-hospital cardiac arrest care may look like as technology, capability, and evidence continue to advance. It is a fascinating area of practice, and Nikki brings frontline insight, experience, and clarity to a topic that is reshaping the conversation around survivability in cardiac arrest.This Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In the final episode of our three-part series marking the anniversary of the 7/7 London bombings, we hear from paramedic Sam Sinclair, who was deployed to Tavistock Square following the fourth and final explosion. This episode brings the series to a close by focusing on the realities of frontline decision-making at a major incident scene and the lasting impact such experiences have.Sam recounts arriving at a scene of profound devastation, rapidly assessing risk, and making critical, time-pressured decisions in an environment defined by uncertainty and loss. In conversation, he reflects on the lessons 7/7 taught him about teamwork, professional instinct, and leadership under pressure, as well as how to carry the emotional and psychological weight of a major incident across a sustained career in emergency medicine.Content Warning: This episode contains detailed and graphic descriptions of traumatic injuries, death, and first-person reflections on the 7/7 bombings. Listener discretion is strongly advised. The views and opinions expressed in this podcast are those of the individual speakers and do not necessarily reflect the views, policies, or positions of any affiliated organizations, employers, professional bodies, or regulatory authorities.The content discussed is intended for educational and informational purposes only. It does not constitute medical advice, clinical guidance, or a substitute for formal training, local protocols, or independent clinical judgment.Clinical decisions should always be made in accordance with current evidence, local guidelines, the scope of practice, and consultation with appropriately qualified healthcare professionals. Listeners are responsible for ensuring that any application of information discussed is appropriate to their own clinical context.

In this episode of the Pre-Hospital Care Podcast, we're joined by Dr Ron Daniels BEM, one of the most influential voices in the global fight against sepsis. Ron is an NHS Consultant in Intensive Care in Birmingham, the Executive Director of the UK Sepsis Trust, and a key member of the Executive Board of the Global Sepsis Alliance. His work has played a central role in shaping national and international policy, including the WHO's landmark 2017 Resolution on Sepsis.Ron's passion lies in translational medicine, turning evidence into practical actions that save lives. He led the team behind the Sepsis 6, a pathway that has transformed early recognition and treatment across the UK. Thanks to these efforts, more than 80% of patients with suspected sepsis in England now receive timely antimicrobials. Yet challenges remain: striking a balance with antimicrobial stewardship, navigating the intricacies of early shock physiology, and recognising that sepsis in the field is often subtle, evolving, and easily missed.In this conversation, we'll explore how pre-hospital teams can recognise sepsis earlier, act decisively, and integrateseamlessly into wider systems of care. From red flags to real-world barriers, from fluids to future pathways, this episode is packed with essential insights for frontline clinicians.The views and opinions expressed in this podcast are those of the individual speakers and do not necessarily reflect the views, policies, or positions of any affiliated organisations, employers, professional bodies, or regulatory authorities.The content discussed is intended for educational and informational purposes only. It does not constitute medical advice, clinical guidance, or a substitute for formal training, local protocols, or independent clinical judgment.Clinical decisions should always be made in accordance with current evidence, local guidelines, scope of practice, and consultation with appropriately qualified healthcare professionals. Listeners are responsible for ensuring that any application of information discussed is appropriate to their own clinical context.This Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In Part 2 of our special three-part series marking 20 years since the 7/7 London bombings, paramedic Adam Desmond shares a deeply personal and unflinchingly honest account of responding to the attacks at King's Cross. This episode centres on the realities of working at the epicentre of a complex, evolving major incident and the lasting impact such events have on those who respond.In conversation, Adam reflects on the initial chaos, the scale of human suffering, and the difficult clinical and moral decisions faced in the confined, hazardous environment of the Underground. He speaks candidly about navigating severe trauma in darkness, confronting system pressures and operational breakdowns, and the personal toll of witnessing mass casualty devastation. Adam also explores the longer-term psychological consequences of the day, including grief, identity, and how the experience continued to shape his life and career long after the incident ended.This is a powerful and important discussion for anyone working in pre-hospital care, emergency medicine, healthcare leadership, or disaster and major incident response.Content Warning: This episode contains detailed and graphic descriptions of traumatic injuries, death, and first-person reflections on the 7/7 bombings. Listener discretion is strongly advised. The views and opinions expressed in this podcast are those of the individual speakers and do not necessarily reflect the views, policies, or positions of any affiliated organizations, employers, professional bodies, or regulatory authorities.The content discussed is intended for educational and informational purposes only. It does not constitute medical advice, clinical guidance, or a substitute for formal training, local protocols, or independent clinical judgment.Clinical decisions should always be made in accordance with current evidence, local guidelines, the scope of practice, and consultation with appropriately qualified healthcare professionals. Listeners are responsible for ensuring that any application of information discussed is appropriate to their own clinical context.⁠This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

Today, we're diving into an increasingly urgent and complex area of frontline medicine: novel psychoactive substances and synthetic drugs. Over the past decade, the drug landscape has shifted dramatically. Potent synthetics, unpredictable chemical variants, and rapidly evolving supply chains are creating new clinical challenges for ambulance crews, HEMS teams, and frontline responders. These substances don't play by traditional rules; presentations can be extreme, toxidromes atypical, and responses to treatment unpredictable. To help us understand this shifting landscape, I'm joined byDr Caroline Copeland, Senior Lecturer in Pharmacology and Toxicology at King's College London and Director of the National Programme on Substance Use Mortality. Caroline is one of the UK's leading experts in drug-related harms, combining pharmacology, epidemiology, and innovative data science to better understand emerging substances and their real-world impact. She advises national bodies, contributes to the ACMD's Novel Psychoactive Substances Committee, and leads national surveillance programmes shaping policy and practice. Today, she helps us unpack what clinicians need to know, what's changing, and how we can better protect patients in a rapidly evolving drug landscape. Caroline's work and publications can be found here: https://www.kcl.ac.uk/people/caroline-copelandThis episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

In this opening episode of a special three-part podcast series marking 20 years since the 7/7 London bombings, we begin with a personal testimony from me on the World Extreme Medicine podcast. This episode is hosted on the Pre-Hospital Care Podcast, with kind permission from the World Extreme Medicine Podcast, hosted by Will Duffin.Part 1 focuses on the immediate response: arriving into uncertainty, operating amid ongoing risk, and delivering care in an environment few clinicians are ever truly prepared for. Eoin reflects on descending into the darkness of the London Underground, the sensory overload of a major incident, and coming face to face with the human cost of mass casualty trauma. This is a raw, unfiltered account of clinical decision-making, emotional impact, and the realities of frontline care on a day that changed everything.Content Warning: This episode contains detailed and graphic descriptions of traumatic injuries, death, and first-person reflections on the 7/7 bombings. Listener discretion is strongly advised. The views and opinions expressed in this podcast are those of the individual speakers and do not necessarily reflect the views, policies, or positions of any affiliated organizations, employers, professional bodies, or regulatory authorities.The content discussed is intended for educational and informational purposes only. It does not constitute medical advice, clinical guidance, or a substitute for formal training, local protocols, or independent clinical judgment.Clinical decisions should always be made in accordance with current evidence, local guidelines, the scope of practice, and consultation with appropriately qualified healthcare professionals. Listeners are responsible for ensuring that any application of information discussed is appropriate to their own clinical context.This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

Today, we're exploring a fascinating and complex topic: the differences and disparities in trauma management systems across NATO nations during the Afghanistan conflict. Coalition operations in Afghanistan brought together militaries with very different medical doctrines, training, and resources. While all aimed to deliver life-saving care in challenging environments, the way pre-hospital trauma was approached varied significantly between countries. From casualty evacuation protocols and triage pathways to interventions like tourniquet use, haemostatic agents, and advanced airway management, these differences had real impacts on patient outcomes.In this episode, we'll delve into how these systems compare, the challenges of interoperability in multinational operations, and the lessons learned that have since shaped modern military and pre-hospital trauma care. Our discussion will also touch on the practical implications for civilian trauma systems and multinational disaster response.Joining me for this conversation is Lt Col Anita Podlasin PhD, Deputy Commander and member of the NATO COMEDS Military Medical Training Working Group. Anita brings extensive experience in military medicine and pre-hospital trauma systems. Together, we'll unpack what worked, what didn't, and how these experiences continue to influence trauma care today. Anita's contact can be found here: https://www.linkedin.com/in/lt-col-anita-podlasin-phd-365a61361?utm_source=share&utm_campaign=share_via&utm_content=profile&utm_medium=ios_appThis episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

In this episode, Laura Hall explores Acute Mountain Sickness (AMS) and the underlying physiology that drives altitude illness. As atmospheric pressure falls with increasing elevation, the body struggles to absorb adequate oxygen, triggering symptoms that often begin as headache, nausea, fatigue, and a “hangover-like” malaise. While these early features are common and often benign, Laura highlights how AMS can progress to far more serious and potentially fatal conditions.The discussion moves into High Altitude Cerebral Oedema (HACE) and High Altitude Pulmonary Oedema (HAPE), outlining their distinct pathophysiology and clinical red flags. Listeners are guided through key diagnostic cues such as worsening ataxia, confusion, or altered behaviour in HACE, and breathlessness at rest, cough, and signs of fluid in the lungs in HAPE.Preventative strategies are also covered, including the importance of gradual ascent, appropriate hydration, and the role of pharmacological prophylaxis such as acetazolamide and, in selected cases, steroids. From a management perspective, Laura emphasises that descent and supplemental oxygen remain the cornerstone treatments for severe altitude illness.Crucially, this episode reinforces the need for clinical vigilance: not every unwell patient at altitude has altitude illness. Clinicians must maintain a broad differential diagnosis and avoid anchoring bias, ensuring that other serious medical conditions are not overlooked or misattributed to AMS, HACE, or HAPE. Read the blog post here: https://highadventurehealthcare.substack.com/p/acute-mountain-sicknessThis Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In this episode of the Pre-Hospital Care Podcast, we delve into the psychology and practice of performing under pressure, examining how we can prepare clinicians not only to survive stress but also to thrive within it.Joining me once again is Andy Bell, Deputy Director of Paramedicine at St John WA, a leading voice in clinical education, leadership, and performance optimisation. Together, we explore how stress inoculation training, cognitive load theory, and deliberate practice can transform the way we teach, lead, and perform in high-stakes environments.We'll explore why traditional ideas of resilience may be holding us back, how entrenched paradigms limit performance, and how rethinking stress can lead to more adaptive and confident clinicians. From the science of “threat versus challenge” mindsets to the power of realistic simulation and reflective education, this episode offers practical insights foranyone working on the frontline of emergency care.This Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In this episode, we explore “The Circle of Life,” a deeply reflective personal narrative by Dr Sarah Spelsberg. The reflection from Sarah captures a powerful sequence of events during a remote medical assignment that starkly illustrates the emotional and clinical breadth of rural and austere medicine.Sarah begins with the peaceful death of a terminally ill patient, setting a quiet and contemplative tone. Just days later, that stillness is shattered when the medical team is urgently called to manage an unexpected and complex outdoor birth in harsh weather conditions. With limited equipment and no initial obstetric setup, the team is forced to rely on adaptability, teamwork, and clinical fundamentals.The narrative details the emergency care provided to both mother and newborn, including the use of remote peer support as Sarah contacts colleagues for guidance on standard post-delivery care. These moments highlight not only the clinical challenges of remote practice but also the importance of professional networks when working in isolation.Sarah concludes by reflecting on the profound juxtaposition of death and birth, describing the experience as both miraculous and terrifying. She contrasts this rare obstetric event with her more familiar work in trauma and orthopaedic medicine, offering a moving meditation on the privilege, responsibility, and emotional weight of caring for patients across the full spectrum of human life. The original blog post can be found here:https://roguemed.medium.com/the-circle-of-life-7b0d448d0b2eThis Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In this episode, we explore something a little different, but deeply connected to everything we do in medicine, leadership, and human connection: the power of storytelling. Whether it's patient handover, clinician-to-clinician stories, or the messroom chat, stories fill our everyday lives. My guest today is Clare Murphy, a world-renowned storyteller who has been bringing the ancient art of story firmly into the modern world since 2006. Clare has performed across the globe, sharing stories with audiences as diverse as the All-Blacks coaches, Mission Critical Teams, scientists, schoolchildren, and even Irish President Mary Robinson. Her work also transcends entertainment. Clare teaches storytelling as a tool for connection, communication, and meaning-making, working with diverse communities that include asylum seekers, climate scientists, social entrepreneurs, firefighters, and veterans who have lost limbs.Her client list speaks volumes: NASA, the All-Blacks, the Mission Critical Team Institute, The Drive Project, Social Entrepreneurs Ireland, Routes Collective, and NHS England. Together, we'll unpack how story shapes the way we understand the world, how it can help us connect with our teams, our patients, and ourselves in the moments that matter most. You can find Clare's work here: https://claremurphy.org/Empirical research suggests that Paramedics routinely recount emergency calls during downtime to make sense of their work. This storytelling functions as a form of tactical resilience to managers, other services, patients, bystanders, and each other, and often involves strong language. The paper can be found here:https://www.researchgate.net/publication/251772924_Heroes_and_Lies_Storytelling_Tactics_among_ParamedicsThis Podcast is sponsored by World Extreme Medicine.World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit:www.worldextrememedicine.com

In this blog audio, Radu Venter emphasises the importance of developing a holistic understanding of the healthcare system, particularly for paramedics whose roles often exist at its edges. Drawing on the experience of observing an organ harvest, Venter highlights the intricate collaboration required among multiple hospital departments and specialists. This complex interplay contrasts sharply with the paramedic's more focused role, centred on rapid assessment, immediate intervention, and safe patient transport.He argues that this necessary specialisation can sometimes limit paramedics' appreciation of the broader system. For example, misunderstandings may arise when paramedics expect nurses or doctors to recall every detail of a patient's journey, not realising that hospital staff manage multiple cases simultaneously within an interconnected network of care.Venter describes paramedics as “transport specialists,” whose strength lies in stabilising patients and bridging the gap between scenes and hospitals rather than delivering definitive treatment. However, he stresses that greater communication and collaboration between pre-hospital and in-hospital teams would benefit both sides. By fostering shared understanding and respect for each role's context and constraints, the healthcare system can function more cohesively, ultimately leading to better coordination, improved patient outcomes, and a stronger sense of collective purpose across all areas of care. You can read the blog post here: https://theparamedicphilosopher.substack.com/p/seeing-the-forest-beyond-the-tree

Today on the Pre‑Hospital Care Podcast, we welcome Dr Maren Ranhoff Hov, a leading figure in the evolving field of pre-hospital stroke medicine. With a unique background that spans both paramedicine and neurology, Maren brings a rare and powerful perspective to the conversation. From her early days working in the ambulance service in Northern Norway, she witnessed firsthand the critical challenges of recognising and treating stroke in the field. This passion would later form the foundation of her research career.Maren has been at the forefront of several groundbreaking projects: most notably, the Norwegian ParaNASPP trial, which explored how paramedics using the NIH Stroke Scale (NIHSS) can improve pre-hospital stroke triage. She has also contributed to pioneering studies on mobile stroke units, pre-hospital CT, and novel telemedicine pathways. Her work has not only shaped stroke protocols in Norway but has also earned international recognition, including a major quality award from the Norwegian Medical Association.On this episode, we'll explore how Maren thinks about the “pre-hospital stroke spectrum” from TIA to large-vessel occlusion and haemorrhagic stroke, and discuss how early decisions in the field can meaningfully change patient outcomes.This is Maren's initial interview on the PHCP in July 2024: https://www.youtube.com/watch?v=v_U8YAmEpncThis is Maren's work on the ParaNASPP trial: https://pubmed.ncbi.nlm.nih.gov/37596006/This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

In this blog audio, Radu Venter challenges the popular narrative that labels paramedics as “heroes,” arguing that while the term may appear respectful, it ultimately does more harm than good. He contends that calling paramedics heroes strips away their humanity, placing unrealistic expectations on their emotional resilience, availability, and ability to cope with trauma. This perception risks normalising overwork and burnout, as it implies that sacrifice and self-neglect are inherent parts of the job.Radu also highlights a key distinction between heroism and professionalism. Heroism, he argues, is by nature extraordinary and temporary, while paramedicine is a lifelong, skilled profession requiring expertise, discipline, and teamwork. Romanticising the work as heroic can discourage sound risk assessment, leading practitioners to take unnecessary risks in the name of perceived bravery.Instead of glorifying paramedics as superhuman, Radu urges society to recognise them as dedicated professionals who deserve proper support, fair working conditions, and respect for their boundaries. He concludes that true appreciation lies not in idolising paramedics but in acknowledging the reality of their role, ordinary people performing extraordinary, often difficult tasks with compassion and competence every day. You can read the blog here: https://theparamedicphilosopher.substack.com/p/paramedics-arent-heroes-and-its-timeThis episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

In this episode of the Pre-Hospital Care Podcast, we explore one of the most powerful yet often misunderstood drivers of excellence in emergency medicine: the culture of clinical leadership. From the early evolution of paramedicine to today'sIn complex, multidisciplinary systems, leadership has never been just about titles or hierarchy; it's about influence, mindset, and the ability to create environments where individuals and teams can perform at their very best.Joining me is Andy Bell, Deputy Director of Paramedicine at St John WA, an internationally recognised educator, clinician, and advocate for evidence-based leadership development. Andy has spent years shaping how we think about high-performance clinical frameworks, embedding human factors, and challenging the fixed thinking that can hold emergency response teams back.Together, we'll unpack the historical context, the challenges and barriers to success, and the practical steps needed to build a culture where clinical leadership thrives. Whether you're a student paramedic, a team leader, or an experienced clinician, this episode will give you actionable insights to strengthen your leadership mindset and help build the next generation of high-performing, compassionate, and adaptive clinical teams.This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

In this episode, we discuss an article by Dr. Sarah Spelsberg titled “HOCUS POCUS, the Magic of Point of Care Ultrasound in Remote and Rural Medicine.” The piece explores the transformative impact of Point of Care Ultrasound (POCUS) in austere, remote, and rural healthcare environments, with a particular focus on the Butterfly Ultrasound device.Dr. Spelsberg outlines the persistent barriers to wider POCUS adoption, including limitations around funding, access to equipment, and adequate training. She then shares her personal journey of fundraising to secure a Butterfly device for her clinic in Unalaska, Alaska, highlighting the practical realities of delivering frontline care in isolated settings.Through a series of powerful clinical case examples, the article demonstrates how POCUS enabled early and accurate diagnoses of serious conditions such as pneumonia, an acute myocardial infarction, and cholecystitis—situations where access to advanced imaging was not available. These cases underscore the device's role in improving diagnostic confidence, expediting care, and directly influencing patient outcomes.Dr. Spelsberg concludes that POCUS is intuitive, accessible, and an essential tool for clinicians working in remote and rural medicine. Its use not only improves patient care but can also help avoid unnecessary, costly, and high-risk medical evacuations.The original blog post can be found here:https://roguemed.medium.com/hocus-pocus-the-magic-of-point-of-care-ultrasound-in-remote-and-rural-medicine-96465b0ba700This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

Today on the Pre-Hospital Care Podcast, we're diving into one of the most critical and often misunderstood areas of pre-hospital care: defibrillation and the future of cardiac arrest management. We're all familiar with the mantra of “shock early,” but how much of what we believe about defibrillation is grounded in evidence, and how much is myth carried forward through tradition and training?To help us separate fact from fiction, I'm joined by Michael Heller, Chief Commercial and Strategy Officer for Corpuls, a company at the forefront of resuscitation technology. Michael brings a unique perspective, not just from the engineering and innovation side, but also from working closely with clinicians worldwide to understand what truly makes a difference at the roadside.In this conversation, we'll explore the enduring myths of defibrillation, the technologies shaping the next generation of devices, and how data, AI, and post–cardiac arrest strategies could redefine survival over the next five years. This is about challenging assumptions, sharpening our practice, and looking ahead to what's possible in saving lives. You can find out more about Corpuls here: https://corpuls.world/en/

Welcome to Best of 2025, Part 2. This collection of episodes reflects some of the most meaningful, challenging, and quietly powerful conversations of the year, the ones that sit at the intersection of clinical excellence, emotional labour, and human experience.We begin with After Death: Understanding Grief in Pre-Hospital Care with Liz Gleeson, Part 2. This episode gave language to something many clinicians carry but rarely articulate: the weight of loss, the presence we hold for families after life has ended, and the cumulative impact that grief has on those working on the frontline. It was a reminder that what happens after death matters just as much as the care delivered before it.From there, we move into one of the most high-stakes scenarios in medicine with Paediatric Cardiac Arrest featuring Paul Banerjee, Paediatric Series Part 3. This conversation explored not only the clinical complexities and time-critical decision-making involved, but also the emotional intensity of managing cardiac arrest in children, and the importance of preparation, teamwork, and reflection in some of the most difficult calls we face.The focus then shifts to leadership, representation, and culture with Women in Critical Care: The Journey, Challenges, and Successes in HEMS with Sophie MacDougall, GWAAC Series Part 2. This episode highlighted the realities of working in high-performance, high-pressure environments, the barriers that still exist, and the progress being made. It was an honest and necessary discussion about inclusion, mentorship, and what strong, compassionate leadership looks like in modern critical care.We then turn to one of the most urgent issues facing pre-hospital services with Suicide Prevention on the Frontline, Mental Health Part 2. This episode addressed the role clinicians play not only in crisis intervention, but in recognising risk, having difficult conversations, and understanding our own emotional responses. It reinforced the idea that suicide prevention is not confined to mental health services; it is part of everyday frontline care.We close Part 2 with Spontaneous Coronary Artery Dissection: The Condition We Often Miss. This conversation challenged assumptions, highlighted diagnostic blind spots, and reminded us that not all chest pain fits the patterns we expect. It was a powerful example of how listening carefully, maintaining curiosity, and questioning heuristics can directly change patient outcomes.Taken together, these episodes reflect the depth and diversity of modern pre-hospital and emergency care, from grief to resuscitation, from equity and leadership to mental health and diagnostic precision. They are conversations that stayed with many of you long after the episode ended. Thanks again to PAX Bags, our long-term sponsor of the podcast. Best-in-class medical bags from PAX can be found here: https://www.pax-bags.com/en/

As we close out this Best of 2025, these episodes represent far more than download numbers or chart positions. They reflect the conversations that resonated most with you, the ones that challenged practice, reinforced fundamentals, and reminded us why this work matters.From Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest with Mike Christian, to The Evolving Nature of Major Incidents with Adam Desmond, Paediatric Assessment in Critical Care with Anna Dobbie, Frailty in Geriatric Patients with Iain Wilkinson and James Adams, and The Last Year of Life focusing on Palliative and End of Life Care; each episode speaks to a different phase of life, a different clinical challenge, and a different kind of responsibility. Together, they capture the full spectrum of pre-hospital and emergency care: from critical care decisions to thoughtful, values-based care at the end of life.They remind us that excellence in practice is not just about technical skill or clinical algorithms, but about clear communication, teamwork, and compassion, whether we are managing traumatic cardiac arrest, supporting families during major incidents, caring for critically unwell children, advocating for frail older adults, or walking alongside patients in their final year of life.Thank you for being part of our podcast community throughout 2025. Your engagement is what makes these conversations possible, and it is a privilege to continue them with you into the year ahead. Finally, thank you to PAX bags for their continued support of the podcast. You can find the best-in-class medical bags here: https://www.pax-bags.com/en/

In today's episode, we're diving into one of the most misunderstood and essential foundations of effective teamwork: psychological safety. Our guest is Dr. Michaela Kerrissey, associate professor at the Harvard T.H. Chan School of Public Health and co-author of the recent Harvard Business Review article, “What People Get Wrong About Psychological Safety.”What does it really mean? Is it about being nice? Feeling comfortable? Or getting your way in team discussions? Michaela's work dismantles these myths and reframes psychological safety as something far more powerful: the ability to speak up, question, challenge, and share critical insights, without fear of ridicule or reprisal.Together, we'll explore how psychological safety applies on the front lines of emergency care, what leaders and crews can do to build it in the moment, and why getting this right might just be the most important culture shift we can make. This conversation is a game-changer for teams that want to grow, perform, and protect each other under pressure. You can read the article here: https://hbr.org/2025/05/what-people-get-wrong-about-psychological-safety?ab=HP-magazine-text-1

In this episode of the Prehospital Care Podcast, we explore a compelling personal medical narrative by Dr Sarah Spelsberg titled “The Not Really an Asthma Attack.” The story centres on a challenging case encountered in a remote island emergency department and highlights the complexity of clinical decision-making when patients do not present in textbook fashion. Dr Spelsberg recounts the case of a 41-year-old man who arrived in severe respiratory distress, initially appearing to be suffering from a life-threatening asthma exacerbation. Standard treatment was commenced, and early investigations, including an ECG and chest X-ray, were undertaken, yet the patient failed to improve as expected.As the clinical picture evolved, it became clear that the initial diagnosis did not fully explain the patient's condition. Further assessment raised concern for a more serious and potentially life-threatening pathology, with features suggesting pericarditis, possibly in the context of a recent viral illness. The narrative captures the difficulty of managing a complex, non-classical presentation in a resource-limited setting, where access to specialist support is constrained, and decisions carry significant risk.Recognising the limits of local capability and the need for specialist input, the team made the critical decision to arrange a medevac transfer to the mainland for cardiology review. Sarah reflects on the case as a powerful reminder of diagnostic humility, the importance of reassessing assumptions when a patient's trajectory does not fit expectations, and the professional responsibility to continue expanding one's medical knowledge. The story resonates strongly with pre-hospital and emergency clinicians, underscoring the realities of uncertainty, vigilance, and adaptive clinical reasoning in high-stakes care. You can read the piece here: https://roguemed.medium.com/the-not-really-an-asthma-attack-c359b8370bbb

In February 2023, the National Guardian's Office dropped a stark warning: the culture in ambulance trusts across England was putting both staff wellbeing and patient safety at risk. Fast forward to this year's Culture Review of Ambulance Trusts, and the findings are just as sobering.According to the 2022 NHS Staff Survey, ambulance services scored below the national average across all seven People Promise areas, including inclusion, wellbeing, morale, and leadership. Over 14% of paramedics reported that their workload was directly damaging their emotional wellbeing. And in terms of speaking up? Many staff who raised concerns said they faced intimidation, ostracism, or silence. The review also highlights ongoing issues with bullying, sexual harassment, poor line management, and a leadership style that too often leans on ‘command and control' rather than compassion. But alongside these findings are six bold recommendations, from fixing the speak-up culture to creating leadership pathways that actually reflect what frontline staff need.So, in today's episode, we're asking, does this report reflect experience working on the frontline? What's missing? And what does genuine culture change look like when you're the one out there answering the calls? I'm joined in this interview by Lee McLaren. Lee is a Paramedic and Practice Educator with the Ambulance Service. With a focus on human-centric leadership, Lee champions compassionate, effective learning environments. His work bridges clinical excellence with the development of future healthcare professionals.You can read the report for the basis of the interview here: https://www.england.nhs.uk/long-read/culture-review-of-ambulance-trusts/

In this episode of the Pre-Hospital Care Podcast, we explore what effective paramedic mentorship should look like, drawing on Radu Venter's article, “What Should Paramedic Mentorship Look Like?” The discussion examines the shortcomings of current orientation practices, highlighting how short and inconsistent programmes frequently leave newly qualified paramedics underprepared and lacking confidence.Many begin their careers paired with partners who have only slightly more experience, creating an environment that can contribute to early-career stress, limited support, and increased vulnerability to error.We introduce Radu's proposal for a more structured approach modelled on medical internships. Under this system, new paramedics would initially work as part of a full, experienced crew, gradually taking on greater responsibility while remaining under the supervision of a seasoned practitioner with at least two years of experience. This tiered framework would allow skills to develop progressively, building confidence and competence before transitioning to independent practice.We also explore evidence from existing models, including a one-year fellowship structure in British Columbia that has reportedly strengthened clinical decision-making, enhanced patient care, and improved practitioner wellbeing. The episode considers what EMS organisations would need to implement such a system, including cultural alignment, investment in senior clinicians, and a commitment to prioritising early-career development.Ultimately, the conversation underscores that structured mentorship is not simply an educational enhancement; it is a patient safety measure and a workforce sustainability strategy. The full article is available at: ⁠https://theparamedicphilosopher.substack.com/p/what-should-paramedic-mentorship⁠This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠⁠https://www.pax-bags.com/en/⁠⁠

On January 13th, 1982, Washington, DC, was paralyzed by a historic snowstorm when catastrophe struck, not once, but twice. Air Florida Flight 90 crashed into the 14th Street Bridge, sending wreckage and passengers plunging into the frozen Potomac River, while across the city, the Metro system suffered its first deadly derailment. Amid chaos and freezing temperatures, first responders, bystanders, and civilians came together in acts of extraordinary courage that defined one of the most harrowing days in the capital's history. In this episode of the Pre-Hospital Care Podcast, we speak with journalist, author, and former EMT Bruce Goldfarb, whose new book 'The Worst Day: A Plane Crash, A Train Wreck, and Remarkable Acts of Heroism in Washington DC ' reconstructs that day minute by minute through the eyes of survivors, rescuers, and witnesses. Drawing from years of interviews and his own frontline experience, Bruce explores not only the operational challenges of that day but also the humanity, the improvisation, compassion, and resilience that emerged from disaster. You can find Bruce's book here: https://www.amazon.com/Worst-Day-Remarkable-Heroism-Washington/dp/1586424165This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

We're joined again today by Radu Venter, Flight Paramedic and Substack blogger. Radu discusses the common sentiment that formal paramedic education is insufficient and that crucial learning happens only during on-the-job practice. Radu also acknowledges that this perspective holds some truth because schooling often overemphasises skills and background knowledge, and can sometimes fail to adequately prepare students for the unpredictability of real patient interactions and essential non-clinical skills like communication and delivering bad news. However, Radu argues that relying solely on on-the-job learning is flawed as practitioners may lack awareness, resources, or opportunities to develop certain competencies, often falling into the existing workplace culture. Therefore, the author suggests that educational institutions should incorporate subjects such as leadership, conflict resolution, humility, and inclusivity into the curriculum to provide a safer environment for developing these critical interpersonal skills before starting practice. You can read the blog here: https://theparamedicphilosopher.substack.com/p/the-real-learning-begins-on-the-jobThis episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

In today's episode of the Prehospital Care Podcast, we explore the complex intersection of adolescent male violence, social media's influence, and its profound impact on the medical professionals responding to these incidents. We're honoured to welcome Dr Naomi Murphy, one of the UK's most respected forensic clinical psychologists and recently appointed Honorary Professor of Psychology at Nottingham Trent University. Naomi brings over 25 years of clinical experience working with complex trauma, particularly among young men who have experienced childhood adversity and gone on to display violent behaviour.The rising tide of youth violence presents unique challenges for prehospital care providers who witness its devastating consequences firsthand. As medical professionals, we often focus on treating physical trauma without fully addressing the psychological dimensions, both for our patients and ourselves. Throughout our conversation, we'll examine the psychological foundations of youth violence, explore how digital platforms have altered its expression, and discuss evidence-based approaches for supporting both victims and the medical professionals who care for them. Dr Murphy's groundbreaking trauma-focused therapy work within high-security settings offers valuable insights for emergency responders experiencing vicarious trauma. You can find Naomi's work here: https://www.centrefortherapy.com/therapists/naomi-murphy/This episode is brought to you by IndieBase.IndieBase is the smart, simple, and budget-friendly Electronic Patient Record (EPR) system designed specifically for the demands of HEMS and pre-hospital care. Whether you're responding solo, working within a flexible team, or managing care across a larger organisation, IndieBase is built to support you. It runs seamlessly on laptops, tablets, or smartphones, and crucially, it operates offline, ensuring you can document care wherever you are, even in the most remote environments. Developed from the proven platform of HEMSbase by Medic One Systems, IndieBase offers a familiar, intuitive interface with the rock-solid reliability clinicians need. It's ready for everything from festival medical cover to high-acuity critical care transfers.Key features include full integration with all major pre-hospital monitors, case review, and clinical governance modules, making it an ideal solution for teams preparing for CQC registration. A patient feedback module also helps drive service improvement and meaningful engagement. For clinicians working across multiple organisations, IndieBase provides a personal logbook that combines your data and links directly with your existing HEMSbase logbook.IndieBase EPR made simple, wherever you are.Find out more at https://indiebase.net/This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

In this episode of the Pre-Hospital Care Podcast, we explore Radu Venter's insightful article “EMS Decision-Making”, which challenges the deeply held belief that faster is always better in emergency medicine. Venter questions the culture of constant urgency in EMS, the idea that every decision must be made in seconds, and argues that this mindset can sometimes compromise patient care, particularly in complex or ambiguous clinical scenarios that exist outside the realm of immediate cardiac arrest.Drawing on the concept of the OODA Loop (Observe, Orient, Decide, Act), Venter highlights its limitations when rigidly applied to paramedic practice. While timely action remains vital, he suggests that taking a moment to pause, observe, and plan can often lead to more accurate decisions and improved outcomes.We discuss how typical EMS training environments, often built around high-speed, high-stress simulations, may inadvertently reinforce reaction over reflection. The conversation explores how a culture of mindful, measured decision-making can empower clinicians to better manage uncertainty, allocate resources effectively, and ultimately provide safer, higher-quality care. Join us as we reframe what “fast” really means in pre-hospital medicine.Read the full article here: https://substack.com/home/post/p-101941847

In this episode, we take a deeper look at the many faces of grief that pre-hospital professionals may encounter in the field, often in subtle, complex, and deeply human ways. While grief is commonly associated with death, it extends far beyond, touching every kind of loss: from separation and divorce to anticipatory grief, perinatal loss, and the unique pain of suicide bereavement.We're joined once again by Liz Gleeson, psychotherapist, educator, and grief specialist, to explore these lesser discussed but critical aspects of grief. Together, we'll examine disenfranchised grief, where people mourn losses that aren't openly acknowledged or socially supported; anticipatory grief, where loved ones begin grieving before a death occurs; and specific experiences such as parental bereavement, sibling loss, grief in older adults, and grief following perinatal loss.We'll also explore how non-death losses like divorce or family estrangement can trigger profound grief responses that may go unrecognised during emergency care. This conversation will help you better understand the many forms grief can take and offer insights into how you, as a pre-hospital professional, can provide more compassionate, informed, and sensitive care during some of life's most difficult moments.You can find Liz's podcast "Shapes of Grief' podcast here: https://podcasts.apple.com/gb/podcast/shapes-of-grief/id1450116449This is Liz's website, where further training on grief can be found: https://shapesofgrief.com/

In this episode of the Pre-Hospital Care Podcast, we explore Radu Venter's powerful piece “No One Dies From Pain”, written under his pseudonym The Paramedic Philosopher. The article challenges one of the most common sayings in Emergency Medical Services (EMS), the idea that “no one dies from pain.” While the phrase may have originated from a focus on rapid transport and prioritising life-saving interventions, Venter argues that this mindset risks neglecting an essential part of paramedic practice: the management of human suffering.Pain is not just a symptom; it's a physiological stressor that can worsen shock, elevate heart rate, and impede recovery. By dismissing it, we not only overlook patient comfort but also potentially compromise outcomes. Venter calls for a more compassionate, patient-centred approach that recognises pain management as integral to modern paramedicine.In this discussion, we unpack how our attitudes toward pain reflect broader cultural values within EMS and consider how clinicians can balance speed with empathy. Join us as we challenge traditional thinking, explore evidence behind pain's physiological impact, and discuss practical ways to ensure comfort and care coexist in the pre-hospital environment.Read the full article here: https://substack.com/home/post/p-103748534

In this episode, we bring together a remarkable group of guests to discuss an often overlooked but incredibly important condition, Spontaneous Coronary Artery Dissection (SCAD). Joining us today are a SCAD survivor, the clinician who treated her, and an advocate working to raise awareness and improve patient outcomes.Together, they share their powerful and unique perspectives on what SCAD is, how it presents, and the challenges faced in recognising it, particularly in the pre-hospital environment, where diagnostic overshadowing can easily occur. We explore why SCAD is sometimes missed, how it differs from other cardiac events, and what clinicians can do to better support patients who may be experiencing it.Most importantly, we hear the real lived experience of surviving SCAD, the uncertainty, recovery, and the crucial role of awareness and advocacy in improving care pathways.This conversation is both educational and deeply human, offering vital insights for pre-hospital professionals, clinicians, and anyone interested in improving outcomes for patients with this rare and often misunderstood condition. Tune in to hear their stories, their expertise, and how we can all play a part in recognising and responding to SCAD more effectively. You can find more on SCAD here: https://beatscad.org.uk/SCAD-for-Patients/What-is-SCAD

In this episode, we explore “Leaving Room for Rougher Edges in EMS” by Radu Venter, a powerful reflection on perfectionism in paramedicine. Radu is a Flight Paramedic based in Canada. He challenges the unrealistic pursuit of flawless performance in an unpredictable, high-pressure environment and asks when “good enough” should truly be enough. We discuss how flexibility, honesty, and self-compassion can replace self-criticism, and how embracing imperfection can actually strengthen team culture and patient care. Join us as we explore the realities of being human in emergency medicine.Read the full article here: https://substack.com/home/post/p-116881333This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at https://www.pax-bags.com/en/

In this episode, we delve into one of the most universal and often misunderstood experiences: grief. Whether it's supporting families after a sudden loss, witnessing trauma firsthand, or coping with personal emotional impacts, grief is an ever-present companion in pre-hospital care.Joining us is Liz Gleeson, a highly respected psychotherapist, educator, and specialist in grief. Liz is the creator of the internationally acclaimed Shapes of Grief podcast and training program, and she lectures widely on grief and loss. With a background in somatic therapies and a PhD in progress on Forest Therapy and bereavement, Liz brings a compassionate, embodied, and deeply informed perspective to the conversation.We'll explore key models of grief, including Kübler-Ross's Five Stages, the Dual Process Model, Attachment Theory, and Continuing Bonds. We'll also discuss the art of listening, cultural competence, caregiver compassion and burnout, and ethical challenges in grief support. This conversation is for anyone navigating the emotional complexities of pre-hospital work and seeking ways to respond with presence, professionalism, and care in moments of profound human vulnerability. You can find Liz's podcast "Shapes of Grief' podcast here: https://podcasts.apple.com/gb/podcast/shapes-of-grief/id1450116449This is Liz's website, where further training on grief can be found: https://shapesofgrief.com/This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life. PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

In this audio blog, Carl Betts employs the analogy of a traditional dry stone wall to explain the principles of healthcare improvement. Carl suggests that just as these walls rely on the careful placement and interconnection of unique stones without mortar, healthcare systems depend on the relationships between processes, people, and policies. A key point is that a single failure or "slippage" in either the wall or the system can cause a cascading disruption. The blog advocates for a thoughtful approach to improvement, stressing that rebuilding requires assessment and learning rather than simply replacing components. Ultimately, the source frames the dry stone wall as a blueprint for success in healthcare, emphasising connection, resilience, and the value of incremental progress.This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at https://www.pax-bags.com/en/

In this episode, we're diving into the journey of Zoe Boswell, a dedicated paramedic, mother, and community volunteer with the Great Western Air Ambulance Charity (GWAAC). Zoe brings over a decade of experience as a road paramedic, all while balancing the demands of family life and volunteering with the GWAAC Heartstarters program.Zoe's story is a powerful example of resilience, progression, and passion within the pre-hospital care world. Her ability to manage complex clinical challenges on scene, train at an advanced level, and still give back to the community through CPR education speaks volumes about her commitment to the profession.In our conversation, we explore her motivations, her aspirations from road to critical care paramedic, the emotional impact of high-acuity cases, and the unique perspective she brings as a parent working on the front line. Whether you're a student paramedic, a seasoned clinician, or just curious about the realities of life on the HEMS pathway, Zoe's insights are both inspiring and deeply grounded in the realities of modern pre-hospital care. Let's dive into this episode with Zoe Boswell.This episode is brought to you by IndieBase.IndieBase is the smart, simple, and budget-friendly Electronic Patient Record (EPR) system designed specifically for the demands of HEMS and pre-hospital care. Whether you're responding solo, working within a flexible team, or managing care across a larger organisation, IndieBase is built to support you. It runs seamlessly on laptops, tablets, or smartphones, and crucially, it operates offline, ensuring you can document care wherever you are, even in the most remote environments. Developed from the proven platform of HEMSbase by Medic One Systems, IndieBase offers a familiar, intuitive interface with the rock-solid reliability clinicians need. It's ready for everything from festival medical cover to high-acuity critical care transfers.Key features include full integration with all major pre-hospital monitors, case review, and clinical governance modules, making it an ideal solution for teams preparing for CQC registration. A patient feedback module also helps drive service improvement and meaningful engagement. For clinicians working across multiple organisations, IndieBase provides a personal logbook that combines your data and links directly with your existing HEMSbase logbook.IndieBase EPR made simple, wherever you are.Find out more at https://indiebase.net/This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

This blog podcast unpacks an article titled "Beyond the Summit: Why Human Factors and Crew Resource Management Matter in Expeditions," written by Ryan Atkinson on 22 September 2025. Ryan asserts that while competence and experience are crucial for expeditions, human factors (HF), the psychological, social, and organisational influences on performance are often the difference between success and disaster. Ryan highlights that stressors like fatigue, ambition, and cognitive biases like Groupthink and Social Proof amplify risk in extreme environments, citing the Tunnel Creek avalanche as an example. To mitigate these risks, the author advocates for the adoption of Crew Resource Management (CRM), an aviation-inspired safety framework focusing on practices like closed-loop communication, checklists, shared situational awareness, and flattened authority gradients. Ultimately, successful expedition teams must evolve from fragile flash teams into structured evolved teams that prioritise collective safety through understanding human limitations and working together. You can read Ryan's blog here: https://ryanatkinson.tv/2025/09/22/beyond-the-summit-why-human-factors-and-crew-resource-management-matter-in-expeditions/

Today, we're diving into one of the most challenging scenarios any EMS provider faces: paediatric cardiac arrest. The figures are challenging, with only a 4.9% survival rate for infants and neurologically intact survival rates as low as 1-4% nationally. These calls have long been considered to have poor outcomes.But what if I told you that one fire department completely rewrote the playbook and achieved neurologically intact survival rates of 46%? What if they did it by breaking conventional rules and staying on scene longer, not shorter?Today, we're joined by Medical Director Paul Banerjee from Polk County Fire Rescue in Florida, where they've transformed paediatric cardiac arrest outcomes through changing the protocols that challenge everything we thought we knew about pre-hospital resuscitation. From their "NO/NO/GO" dispatch system to permissive hypercarbia post-intubation, from mechanical CPR to aggressive on-scene airway management, Polk County has proven that with the right approach, we can dramatically improve outcomes in this patient cohort. *** Please note, this podcast is for information purposes only. You must stay within your scope and remit of practice and service SOPs at all times ***This podcast is sponsored by BlueRoomXRWhen lives are on the line, training needs to feel real. That's where BlueRoom comes in, the world's most advanced mixed-reality training simulator. No bulky controllers or gimmicks, just your hands, your kit, and a level of immersion that places you straight into the mission. From the cockpit of a Blackhawk to the chaos of a combat zone, BlueRoom delivers pressure-filled environments without real-world risk.With Mission Control, instructors can shift conditions, change patient vitals, and dial up intensity instantly. And thanks to Garmin biometrics, the system even responds to your physiology in real time, adapting as your stress and heart rate rise.Born in Australia and now trusted across five continents, BlueRoom is redefining readiness for military, medical, and frontline professionals. This isn't the future of training; it's training transformed.

This is the second audio blog, written by Dr. Will Duffin, detailing medical considerations and avoidance techniques for leeches, bullet ants, and mosquitoes, which are common threats in tropical environments. This guide provides practical advice on managing bites and highlights the importance of malaria prophylaxis and insect repellent for effective expedition planning. You can read the blog here: https://worldextrememedicine.com/blog/jungle-medicine-posts/jungle-survival-guide/World Extreme Medicine has given kind permission to use this blog post.This podcast is sponsored by BlueRoomXRWhen lives are on the line, training needs to feel real. That's where BlueRoom comes in, the world's most advanced mixed-reality training simulator. No bulky controllers or gimmicks, just your hands, your kit, and a level of immersion that places you straight into the mission. From the cockpit of a Blackhawk to the chaos of a combat zone, BlueRoom delivers pressure-filled environments without real-world risk.With Mission Control, instructors can shift conditions, change patient vitals, and dial up intensity instantly. And thanks to Garmin biometrics, the system even responds to your physiology in real time, adapting as your stress and heart rate rise.Born in Australia and now trusted across five continents, BlueRoom is redefining readiness for military, medical, and frontline professionals. This isn't the future of training; it's training transformed.

In today's episode, we're exploring the evolving role of women in Helicopter Emergency Medical Services (HEMS) and pre-hospital critical care, inspired by insights from Critical Care Doctor Sophie MacDougall. Sophie highlights both the unique challenges and the incredible rewards that come with working in this demanding, fast-paced environment, one that remains largely male-dominated but is gradually becoming more diverse.We'll hear from guests who share their journeys into HEMS and air ambulance work, reflecting on what the job gives back to them every day and how they have navigated their career paths within GWAAC. From overcoming barriers and difficult moments to the importance of mentors, whether male or female, our guests reveal the critical lessons they've learned along the way.This episode also delves into the steps needed to encourage more women to join HEMS teams, breaking down stereotypes and showing that this field is not just a “men's world.” We'll discuss how initiatives like the GWAAC ‘Fem in PHEM' event are making a difference and how ongoing support and visibility can inspire the next generation of female critical care professionals.Whether you're a clinician, a student, or simply curious about pre-hospital care, this conversation offers valuable perspectives on resilience, aspiration, and inclusion in one of healthcare's most challenging specialties.This podcast is sponsored by BlueRoomXRWhen lives are on the line, training needs to feel real. That's where the BlueRoom Simulator comes in, the world's most advanced mixed-reality medical simulator. No bulky controllers or gimmicks, just your hands, your kit, and a level of immersion that places you straight into the mission. From the cockpit of a Blackhawk to the side of a cliff, BlueRoom delivers pressure-filled environments without real-world risk.
With a Mission Control dashboard, instructors can shift conditions, change patient vitals, and dial up intensity instantly. And thanks to Garmin biometrics, the system even responds to your physiology in real time, adapting as your stress and heart rate rise.
Born in Australia and now trusted across five continents, BlueRoom is redefining readiness for military, medical, and frontline professionals. This isn't the future of training; it's training transformed.


This blog post, written by Dr Will Duffin, addresses the benefits of in-situ wilderness simulation training for medical professionals working in remote environments. Written by Dr. Will Duffin, this blog post unpacks his experience providing medical cover for the TV show Survivor to illustrate how practicing emergency scenarios on-site helps teams improve emergency management skills, foster team bonding, and 'battle test' equipment and processes before real incidents occur. The article explicitly links this training methodology to the World Extreme Medicine organisation, highlighting their range of specialised medical courses and academic programs focused on various extreme and remote settings like polar, space, and ocean medicine. Ultimately, the blog is an informative piece advocating for low-stakes, context-specific simulation training while simultaneously serving as a promotional tool for the organisation's educational offerings and conferences. You can read the blog here: https://worldextrememedicine.com/blog/extreme-medicine-posts/train-hard-fight-easy-the-benefits-of-in-situ-wilderness-simulation-training/World Extreme Medicine has given kind permission to use this blog post. This podcast is sponsored by BlueRoomXRWhen lives are on the line, training needs to feel real. That's where BlueRoom comes in, the world's most advanced mixed-reality training simulator. No bulky controllers or gimmicks, just your hands, your kit, and a level of immersion that places you straight into the mission. From the cockpit of a Blackhawk to the chaos of a combat zone, BlueRoom delivers pressure-filled environments without real-world risk.With Mission Control, instructors can shift conditions, change patient vitals, and dial up intensity instantly. And thanks to Garmin biometrics, the system even responds to your physiology in real time, adapting as your stress and heart rate rise.Born in Australia and now trusted across five continents, BlueRoom is redefining readiness for military, medical, and frontline professionals. This isn't the future of training; it's training transformed.

In pre-hospital care, paramedics regularly encounter patients with a wide range of mental health conditions. From anxiety and depression to psychosis and self-harm, the ability to quickly assess and manage these conditions is crucial in ensuring the best possible outcome for the patient. But how do paramedics navigate the complexities of mental health?In the field, where resources are limited and time is critical. In this episode, we explore the most encountered mental health pathologies in pre-hospital care, focusing on how paramedics assess, manage, and provide care for these patients under high-pressure circumstances. From acute anxiety attacks to bipolar disorder episodes, we discuss the unique challenges paramedics face when dealing with patients experiencing severe psychological distress.We'll also delve into the importance of collaboration between paramedics, mental health crisis teams, and other emergency responders (Multi-Disciplinary Team/MDT approaches). How do these teams work together to ensure a seamless care pathway for patients who may need urgent mental health support? This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

This is the second installment from Ryan Atkinson's blog post, "Let's talk about climate hypocrisy and carbon democracy…," which addresses the common accusation of hypocrisy faced by environmental activists. Ryan, a filmmaker focusing on conservation, acknowledges his own air travel, which contributes to global CO2 emissions, yet argues it is necessary for communicating and effecting systemic change. He frames such criticism as a personal attack designed to shut down debate, suggesting that living a perfectly non-hypocritical life within a carbon-dependent society is nearly impossible for those seeking to make an impact. Instead, he advocates for embracing perceived hypocrisy as a starting point for dialogue about climate change and the pervasive influence of the carbon economy. Ultimately, the blog champions the idea that individual actions, even imperfect ones, can contribute to larger structural change if they serve a greater purpose. You can read the blog post here: https://ryanatkinson.tv/2020/03/02/lets-talk-about-climate-hypocrisy-and-carbon-democracy/This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

Today, we are joined by Dr Celestine Weegenaar, the first female PHEM trainee at Great Western Air Ambulance Charity (GWAAC). Originally from Amsterdam and now firmly rooted in the South West of England, Celestine brings a wealth of experience from emergency departments across the region – and even from the skies of Australia, where she flew with LifeFlight.We talk about her journey into pre-hospital emergency medicine, what drew her to the field, and how she's navigating the challenges and rewards of her current role. From the adrenaline of high-acuity pre-hospital care to the quiet moments of learning and growth alongside GWAAC's critical care team, Celestine reflects on the reality of life as a trainee in this dynamic and demanding specialty.As the new Chair of the Pre-Hospital Emergency Medicine Trainees' Association (PHEMTA), she also shares her vision for increasing inclusivity in the field, breaking down barriers, and supporting more women to pursue careers in PHEM. Whether you're an aspiring critical care clinician or simply interested in the people behind the patch, this episode offers a personal and inspiring look into the life and values of a rising leader in pre-hospital care.This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠

Ryan Atkinson's "Local Loss in a Global Crisis" explores the disconnect between Western perceptions of climate change and its tangible effects on vulnerable communities, specifically in the Langtang Valley of Nepal. Ryan reflects on his personal carbon footprint and the ethical implications of his travels while witnessing the devastation caused by the 2015 earthquake, exacerbated by climate change. Ryan highlights the resilience and enduring spirit of the local people, who face immense challenges despite having contributed little to the global crisis. The piece ultimately underscores the profound impact of global environmental issues on local lives, compelling Ryan to advocate for these stories. You can read the blog post here: https://ryanatkinson.tv/2020/02/22/local-loss-in-a-global-crisis/This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at https://www.pax-bags.com/en/

Every year, thousands of lives are lost to suicide, and emergency responders are often the first line of support during these critical moments. In this episode, we explore the vital role that the London Ambulance Service (LAS) plays in suicide prevention and risk assessment. From the moment a call comes into the control room to the interaction on the frontline, paramedics are trained to recognise the signs of suicidal ideation and act quickly to prevent harm.We'll dive into the clinical and operational aspects of suicide risk management, discussing how paramedics assess high-risk patients and work alongside police, mental health crisis teams, and hospitals to ensure the best possible care. You'll learn about the collaborative efforts that help create a seamless response for those in the most vulnerable states, as well as the challenges involved in coordinating care across various agencies.This episode offers a candid look at the realities of suicide prevention in pre-hospital care and the steps that can be taken to save lives.

In this episode, we reflect on the article “Asking Why. Telling Stories. Owning Accountability” and its lessons for both the diving community and pre-hospital care. The piece explores how adverse events are too often met with blame and silence, when what's needed is open storytelling, systemic accountability, and visible learning. Drawing on three academic theses, the author argues for a shift from backward-looking, individual blame towards forward-looking, relational accountability approaches that foster trust, resilience, and safer systems.Barriers such as fear of reputational harm and legal concerns frequently stifle honest reflection. Yet, the article suggests that structured, context-rich narratives can create a culture of genuine learning and justice, allowing organisations to adapt and prevent future harm.For pre-hospital care, the parallels are striking. Just like in diving, providers face high-stakes environments where “first stories” may oversimplify, overlooking the complex contexts in which clinicians operate. Whether in remote environments, critical incidents, or everyday EMS work, learning requires moving past blame and toward systems thinking. Transparent communication, structured debriefs, and the courage to challenge norms are as vital to paramedics and pre-hospital teams as they are to divers and expedition leaders.By embracing this approach, telling richer stories, strengthening feedback loops, and redefining accountability, we can better support both patients and providers in the moments when things go wrong. Read the blog post here: https://www.thehumandiver.com/blog/asking-why-telling-stories-and-owning-accountability-lessons-for-divingYou can contact Gareth Lock here: https://www.thehumandiver.com/contact-us-2025

Today, we're exploring some of the complexities of real-life palliative care cases that frontline staff have faced in practice. Joining me are four members of the London Ambulance Service's dedicated Palliative and End-of-Life Care Team: Karina Catley, Natalie Nabunya, Rowena Rickson, and Jodie Grace. Together, we'll examine real-life case studies that illustrate the unique challenges of caring for patients and their families during their final moments. From managing uncontrolled seizures in the community to supporting a family's cultural and spiritual wishes after death, these stories highlight the difficulties of decision-making when time is limited, documentation is incomplete, and emotions are intense. Along the way, we'll explore key principles such as the doctrine of double effect, the role of shared decision-making, and the importance of recognising dying in the field. We'll also discuss how clinicians can communicate compassionately, respect cultural values, and navigate the legal and public health frameworks that guide this care. This is a conversation about dignity, humanity, and the privilege of supporting people at the end of their lives, offering lessons for all of us working in pre-hospital care.

This episode dives into a critical article arguing that the diving industry too often fails to learn effectively from fatalities, not because of individual mistakes, but due to systemic shortcomings. It distinguishes between “first stories”, simple narratives that assign blame, and “second stories”, deeper explorations into context, drift from safety standards, and the normalisation of deviance.The tragic death of Linnea Mills is used as a case study, showing how multiple factors, equipment incompatibility, insufficient supervision, and the challenges of a remote location, aligned to create a disaster. Rather than focusing only on compliance or individual error, the article calls for a systems-based approach to safety: stronger feedback loops, better emergency preparedness, and a culture where speaking up about risks is encouraged.For divers, instructors, and responders, this also underscores the importance of effective pre-hospital care. Here are key resources:Divers Alert Network: First Aid & Emergency CareWHO: Prehospital Trauma Care SystemsNAEMT: Prehospital Trauma Life Support (PHTLS)EMS World: Best Practices in Prehospital CareBy combining systemic safety improvements with robust pre-hospital care readiness, the industry can better prepare for emergencies and reduce the likelihood of preventable tragedies.You can read the blog post here: https://www.thehumandiver.com/blog/we-don-t-learn-from-diving-fatalities-and-here-s-whyYou can contact Gareth Lock here: https://www.thehumandiver.com/contact-us-2025

Mental health crises are one of the most complex and sensitive challenges faced in pre-hospital care. The London Ambulance Service (LAS) plays a critical role in responding to these emergencies, from the moment a 999 call is made to frontline crews delivering urgent interventions. But how does the system work as a whole? How are these calls assessed in the control room, and what role do specialist paramedics and mental health professionals play in shaping patient outcomes?In this episode, we dive deep into Pre-Hospital Mental Health Response, exploring how the LAS manages real-time mental health incidents, the operational and clinical decision-making that happens behind the scenes, and the challenges of coordinating care across multiple agencies. We'll hear about the evolving role of mental health-trained paramedics, case studies of successful interventions, and the key lessons learned from high-risk situations.Joining us are colleagues from the London Ambulance Service Mental Health Team, who will share their experiences from both the frontline and the Emergency Operations Centre (EOC), giving us a full picture of how pre-hospital mental health care is delivered in one of the busiest ambulance services in the world.This episode is a deep dive into how mental health services are integrated and embedded within an ambulance service as a fundamental part of emergency care service delivery to the population. This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at https://www.pax-bags.com/en/

This blog is a personal reflection from Advanced Paramedic Wayne Auton, who shares how he has recently embraced what he describes as a “position of yes.” This mindset involves being open and willing to accept opportunities as they arise, often at short notice, and focusing on the positive potential that each opportunity may bring. Wayne acknowledges that it is a fortunate position to be in, but one that has significantly transformed his outlook and boosted his overall positivity.For many years, Wayne found himself caught in a cycle of negative thinking. He often focused on what might go wrong, rather than what could go right. This tendency led to decreased confidence, increased caution, and a general reluctance to take risks. It was a mindset he found restrictive and disheartening.He reflects on how he used to default to worst-case scenarios, frequently overlooking the possible benefits of a situation. Research supports this pattern; negative events tend to be more intense and memorable because they require greater mental effort to process (Taylor, 1991). Recognising this has helped Wayne shift his focus. By choosing to say yes more often, he has created space for growth, confidence, and optimism.You'll also hear an AI-narrated summary of this blog, bringing Wayne's reflections to life through audio. You can read the blog here: https://wayneauton.blogspot.com/2021/03/say-yes-to.htmlThis episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at https://www.pax-bags.com/en/

Today, we're diving into the high-stakes intersection of tactical medicine, crisis negotiation, and pre-hospital care with Eric Acevedo, a seasoned professional operating at the front lines of some of Virginia's largest emergency response operations. Eric brings a rare blend of experience across tactical EMS, hostage negotiation, and field-based crisis response, offering a unique perspective on how communication, psychology, and calmness under pressure can save lives.In this episode, we'll explore the foundational principles of crisis and the wider art of negotiation and how those same tools can be applied by EMS providers in their daily work, especially when it comes to de-escalating tense situations, communicating effectively with patients in distress, or persuading someone to accept lifesaving treatment.We'll also look at the human side of this work: emotional regulation, interdisciplinary collaboration, and lessons learned from real-world case studies where negotiation and medicine intersected in critical moments. This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at https://www.pax-bags.com/en/