In pre-hospital care, timing isn’t just important; it’s everything. The difference between a good outcome and a devastating one can come down to minutes and decisions, and few decisions are more critical than knowing when to bring advanced critical care to the scene.

In this episode, we’re joined by Critical Care Paramedic Callum Sutton from Great Western Air Ambulance Charity (GWAAC) to explore a question that sits at the heart of pre-hospital medicine: when does HEMS truly add value? This isn’t about calling early for the sake of it; it’s about understanding the patients, the physiology, and the interventions that can change trajectories.

But just as important is what happens before the helicopter lands. From optimising access and monitoring to anticipating procedures like pre-hospital emergency anaesthesia, small actions on the ground can translate into critical time saved. This is a conversation about foresight, teamwork, and marginal gains, and how, in the right moments, those gains can mean everything.

This episode is supported by the Great Western Air Ambulance Charity (GWAAC).

GWAAC’s Clinical Symposium takes place on Friday, 16 October 2026, at Ashton Gate Stadium, Bristol, with this year’s theme: Innovation. The event will focus on practical, implementable ideas shared by GWAAC’s Critical Care Team and guest speakers, designed for clinicians to take directly back into practice and apply quickly, rather than years down the line.

• Limited availability: ~120 tickets only
• Tickets on sale from June 2026
• Early interest sign-up is available now
• Also includes updates on other GWAAC clinical engagement events

Find out more and register interest: https://gwaac.com/symposium

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 geriatric compilation explores the intersecting challenges of frailty, falls, and delirium in older adults, core issues in both pre-hospital and acute care. Frailty increases vulnerability to injury and poor outcomes, with falls often resulting in hospitalisation, loss of independence, and increased mortality. Alongside this, delirium remains common yet frequently under-recognised, often triggered by infection, dehydration, medications, or chronic disease, and presenting significant diagnostic and management challenges.

We examine structured approaches to assessment, including frailty scoring and cognitive evaluation, alongside the practical realities of decision-making in time-critical environments. A key focus is the differentiation between delirium, dementia, and other causes of confusion, and how sensory impairments can further complicate communication and assessment. The episode emphasises the importance of empathy, particularly when engaging with patients and families during periods of acute vulnerability.

Attention is given to the interface between pre-hospital and hospital teams, exploring barriers to effective communication, the importance of structured handovers, and the development of proactive, multidisciplinary care pathways to reduce recurrent harm. Ethical considerations, family dynamics, and prevention strategies are also discussed.

Featuring insights from Iain Wilkinson, James Adams, and Georgie Gill, this episode highlights integrated, system-wide approaches to improving outcomes for older patients.

You can listen to the individual episodes here: 

Frailty in Geriatric Patients with Iain Wilkinson and James Adams. Part 1, Geriatric Series: https://podcasts.apple.com/gb/podcast/frailty-in-geriatric-patients-with-iain-wilkinson/id1441215901?i=1000695425594

Delirium, Confused States, and Elderly Pathologies with Iain Wilkinson and James Adams. Part 2, Geriatric Series: https://podcasts.apple.com/kz/podcast/delirium-confused-states-and-elderly-pathologies-with/id1441215901?i=1000698533443

Improving communication and decision-making within Geriatric care. Part 3, with Iain Wilkinson and Georgie Gill: https://podcasts.apple.com/kz/podcast/improving-communication-and-decision-making-within/id1441215901?i=1000700542486

⁠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 today’s conversation, we move beyond the idea of simply recording numbers in the cardiac arrest patient. Instead, we explore how physiological data can be used to guide real-time resuscitation, helping clinicians understand what is happening inside the patient, how interventions are working, and where care should go next. 

Joining us as the guest to discuss this is Mark Faulkner. Mark is an Advanced Paramedic for Hampshire and Isle of Wight Air Ambulance (HIOWAA), where he provides clinical leadership through his critical care practice. His work spans frontline practice, education, quality improvement, and the development of clinical pathways that shape the delivery of advanced pre-hospital care. This is the reading list associated with the episode:

Barreto, A. et al. (2020) ‘Diastolic blood pressure and survival in cardiac arrest’, Resuscitation, 155, pp. 1–8.

Bernard, S.A. et al. (2024) ‘Physiology-guided resuscitation in cardiac arrest’, Journal of Clinical Medicine, 13(12), p. 3527.

Brede, J.R. et al. (2019) ‘Prehospital REBOA in cardiac arrest’, Resuscitation, 140, pp. 136–143.

Butterfield, E. et al. (2024) ‘Prehospital arterial monitoring in cardiac arrest’, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1).

Kruit, N. et al. (2025) ‘Prehospital ECPR (PRECARE study)’, Resuscitation, 188.

Nolan, J.P. et al. (2021) ‘European Resuscitation Council Guidelines’, Resuscitation, 161, pp. 98–114.

Perkins, G.D. et al. (2018) ‘Epinephrine in OHCA’, New England Journal of Medicine, 379(8), pp. 711–721.

Rubertsson, S. et al. (2014) ‘LINC trial’, JAMA, 311(1), pp. 53–61.

Sutton, R.M. et al. (2014) ‘Hemodynamic-directed CPR’, Resuscitation, 85(3), pp. 397–402.

Yannopoulos, D. et al. (2020) ‘Advanced reperfusion strategies’, Circulation, 141(10), pp. 784–796.

Rees, P. et al. (2023) ‘Prehospital arterial blood pressure monitoring and outcomes in cardiac arrest’, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.

Barrett, J. et al. (2023) ‘Diastolic blood pressure and ROSC in OHCA’, Resuscitation.

VitalStream from BHA Medical sponsors this podcast: Closing the Haemodynamic Blind Spots in Acute and Pre-Hospital Care

VitalStream is a wireless, wearable, non-invasive haemodynamic monitoring platform designed to deliver continuous, real-time physiological data, so you’re not relying purely on intermittent cuff readings when patients are unstable, moving, or in non-traditional care environments.

Using AI-driven analytics and patented Pulse Decomposition Analysis, it provides continuous blood pressure alongside advanced haemodynamic parameters such as cardiac output, stroke volume, systemic vascular resistance, and fluid status. The aim is simple but critical: to help clinicians understand not just what the blood pressure is, but why, and whether a patient is fluid responsive or in need of a different intervention.

BHA Medical’s VitalStream solution focuses on integrating this level of monitoring into acute care workflows, streaming real-time data to a centralised platform, supporting earlier recognition of deterioration and more informed clinical decision-making.

In corridor medicine, where patients are often managed outside traditional monitored spaces, the challenge is missed deterioration between spot checks. Continuous trending helps reduce those “blind spots,” enabling earlier identification of haemodynamic decline and better prioritisation when systems are under pressure.

And in pre-hospital care, the value is in maintaining a clear physiological narrative from first patient contact through to hospital handover. VitalStream is designed for rapid deployment, applied, calibrated, and delivers data within around 90 seconds, using a low-pressure finger sensor that allows teams to follow trends in real time, rather than relying on isolated snapshots.

For more information, visit: https://www.bha-medical.com/vitalstream-patient-monitoring

In this episode, we explore the critical factors shaping maternal and neonatal outcomes in the pre-hospital environment, bringing together expert insights from Camella Main, Dawn Kerslake, and Stephanie Heys. Camella, a Consultant Midwife with over 12 years’ experience across both hospital and pre-hospital settings, shares her perspective from her roles with the London Ambulance Service and East Midlands Ambulance Service, where she leads on improving maternity care through evidence-based practice.

The conversation focuses on the realities of managing high-risk pregnancies and neonatal care outside the hospital, particularly in rural and remote settings. We examine current guidelines, emerging trends, and practical strategies to optimise outcomes for both mother and baby. A key theme is the immediate care of the newborn, with a detailed discussion on thermal management, why it matters, common pitfalls, and the techniques and equipment that can make a critical difference in those first minutes after delivery.

We also explore the broader system challenges: how paramedics are trained and supported in maternal and neonatal care, the role of clinical governance, and the importance of structured follow-up and ongoing support for patients. The panel addresses a significant gap in pre-hospital maternity research, highlighting both the challenges and the urgent need for further evidence to guide practice.

This episode offers a comprehensive and practical look at pre-hospital maternity care, combining frontline experience, clinical expertise, and a forward-looking discussion on how the field must evolve to improve outcomes for mothers and newborns. You can listen to the separate previous episodes here:

https://open.spotify.com/episode/7vjqHk5SZXeW5HMjtZuGfm

https://podcasts.apple.com/gb/podcast/the-future-of-pre-hospital-maternity-care/id1441215901?i=1000648721307

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 on the Pre-hospital Care Podcast, we dive into the growing role of high-fidelity simulation in improving clinical performance, team coordination, and patient outcomes in pre-hospital care systems. Simulation has moved beyond an educational luxury to become a strategic tool for preparing clinicians for the unpredictable and high-stakes nature of pre-hospital emergency medicine. In this episode, we explore not only the advantages of realistic experiential training but also the critical role of targeted debriefing and video-assisted debriefs in cementing learning, enhancing psychological safety, and driving measurable performance improvements.

Our guest is Ben King, Founder and Chief Executive Officer of Best Practice Medicine, a clinician-founded, Montana-based organisation dedicated to experiential healthcare education, high fidelity simulation, travel paramedicine, and EMS response services. 

Ben is widely recognised as a thought leader in resuscitative medicine, team dynamics, and human performance under stress, and has been a driving force in expanding the use of high-fidelity simulation to prepare providers for real-world clinical complexity.

You can find Best Practice Medicine here: https://bestpracticemedicine.com/

In this compelling compilation series on Traumatic Brain Injury (TBI), the conversation unfolds through the combined expertise of Mark Wilson and David K. Menon, offering a layered exploration of one of medicine’s most complex and high-stakes challenges. Across these episodes, listeners are guided through both the immediate realities of head trauma and the deeper physiological battles that follow.

Consultant neurosurgeon Mark Wilson discusses the fundamentals of head injury, focusing on brain injury, primary and secondary injury, venous drainage, and optimising pre-hospital management. As a specialist in acute brain injury at Imperial College and an Air Ambulance doctor, Mark brings a frontline perspective where early decisions can significantly shape patient outcomes.

Professor David K. Menon joins for an in-depth exploration of TBI. As the Founding Director of the Neurosciences Critical Care Unit at Addenbrooke’s Hospital, he has been instrumental in shaping modern understanding of TBI physiology, monitoring, and management. His insights illuminate the complex cascade of secondary injury processes that evolve after the initial trauma.

Together, these episodes emphasise a central truth: TBI is not a single event, but a dynamic process requiring precision, timing, rehabilitation, and evolving clinical insight. You can listen to the original episodes here:

Trauma Series Part 3: Head Trauma with Mark Wilson: https://podcasts.apple.com/gb/podcast/trauma-series-part-3-head-trauma-with-mark-wilson/id1441215901?i=1000670004308

TBI: The Battle for the Injured Brain with Professor David Menon: https://podcasts.apple.com/gb/podcast/tbi-the-battle-for-the-injured-brain-with/id1441215901?i=1000752384742

In this session, we’re joined by Professor Daniel Patterson, one of the leading international voices on fatigue, safety, and evidence-based policy in Emergency Medical Services. Daniel is a PhD-qualified researcher, Nationally Registered Paramedic, and Professor of Emergency Medicine at the University of Pittsburgh. Daniel’s work sits at the intersection of frontline EMS practice, sleep science, and systems-level safety. He has led some of the most influential research programmes examining how fatigue affects clinicians, patients, and organisations, and, critically, what can be done about it.

This conversation centres on the Fatigue in EMS Project, a landmark body of work that applied rigorous systematic review methodology to underpin the first evidence-based guidelines for fatigue risk management in EMS. Rather than relying on tradition or opinion, this research interrogates what the evidence tells us about shift length, napping, caffeine, education, workload, and fatigue modelling. Together, we’ll explore fatigue as a patient safety issue, challenge endurance culture, and discuss how high-quality evidence should shape the way EMS systems are designed and led.

To read the studies mentioned in the podcast, please see here:

https://www.sciencedirect.com/science/article/pii/S2352721822001814

https://pubmed.ncbi.nlm.nih.gov/29324053/

https://pmc.ncbi.nlm.nih.gov/articles/PMC3228875/

This Paediatric Critical Care Compilation brings together three of the most important conversations we’ve released on the Pre-Hospital Care Podcast. Caring for critically unwell or injured children in the pre-hospital environment is rare, high-stakes, and cognitively demanding, and getting it right matters.

In Part 1, we speak with Anna Dobbie on Paediatric Assessment in Critical Care with a focus on the fundamentals of paediatric assessment. From structured approaches to airway, breathing, circulation, and neurological evaluation, to recognising the subtle red flags that signal serious illness, this episode builds a framework for managing children of all ages under pressure.

Part 2 expands into the conditions you are most likely to encounter in the field. Joined by Sarah Edwards, we explore respiratory infections, asthma, seizures, gastroenteritis, dehydration, febrile illness, and trauma. The emphasis is on pattern recognition, early prioritisation, and avoiding common pitfalls. We also examine the critical role of caregivers and the communication skills required to manage fear, uncertainty, and complexity in real time.

In Part 3, we tackle one of the most challenging scenarios in pre-hospital care, Paediatric Cardiac Arrest, with Medical Director Paul Banerjee. With historically poor outcomes, we explore how one system has achieved dramatically improved survival through protocol innovation and a willingness to challenge convention.

Across all three episodes, a central principle remains: these discussions are designed to inform and provoke thought, but practice must always align with your local guidelines, governance, and system capabilities. This is essential listening, content that has the potential to directly influence how we care for our sickest patients.

You can listen to each episode here:

Part 1: https://podcasts.apple.com/gb/podcast/paediatric-assessment-in-critical-care-with-anna/id1441215901?i=1000705648049

Part 2: https://podcasts.apple.com/gb/podcast/recognising-red-flags-a-guide-to-paediatric/id1441215901?i=1000708533081

Part 3: https://podcasts.apple.com/gb/podcast/paediatric-cardiac-arrest-with-paul-banerjee/id1441215901?i=1000733614357

In this episode, we explore how REBOA can become an integrated tool for deliberate physiologic support in profound shock. REBOA is a word that immediately commands attention in pre-hospital care. For many teams, it represents the edge of capability, a high-stakes intervention reserved for catastrophic haemorrhage and profound shock.  Many clinicians still think of it primarily as a haemorrhage-control device: inflate fully, plug the leak, and hope for the best. But in profound shock, bleeding is only part of the problem. Coronary perfusion hinges on proximal aortic diastolic pressure, and if the heart isn’t being perfused, everything else we do is on borrowed time.

Today’s guests, Dr Jon Barratt and Dr Halden Hutchinson-Bazely, sit at the cutting edge of this shift in thinking. Jon is a Consultant in Emergency Medicine and Pre-Hospital Emergency Medicine with the British Army and the NHS, serving as Clinical Lead for Research and Clinical Innovation at Yorkshire Air Ambulance and as a MERIT Consultant with West Midlands Ambulance Service. He is a Senior Lecturer with the Academic Department of Military Emergency Medicine and a founding force behind the SPEAR programme, a resuscitation training initiative that leverages ultrasound-guided arterial access and physiologic targets to support patients in deep shock. Jon was also principal investigator for the ERICA-ARREST trial, investigating the use of REBOA to augment coronary perfusion in out-of-hospital cardiac arrest. 

Hutch is a pre-hospital care doctor at London's Air Ambulance (LAA), specialising in exsanguination, and an intensive care doctor at St Bartholomew’s Hospital, specialising in ECMO. He is practising in endovascular resuscitation across the spectrum of the medical and trauma fields. Together with Jon, he is a SPEAR and EVTM faculty member and was an investigator for ERICA-ARREST. He brings a thoughtful and clinically grounded perspective to trauma management, with a focus on practical decision-making in high-pressure environments. His work reflects a commitment to evidence-informed practice and continual learning within acute care systems.

You can find more on SPEAR here: https://journals.sagepub.com/doi/10.1177/11297298241242157

And here: https://www.eaaa.org.uk/what-we-do/research-and-education/clinical-education/spear

Today’s episode, Trauma Fundamentals: Chest, Pelvis & Spine, brings together a curated compilation of three core areas of major trauma that every pre-hospital clinician must be confident in managing.

In this episode, we revisit thoracic trauma with Dr Geoff Healy, exploring the life-threatening pathologies that demand early recognition and decisive intervention. We then move into pelvic trauma with Dr Ash Vasireddy, unpacking the nuances of pelvic assessment, the significance of the mechanism of injury, and the importance of early stabilisation. Finally, we round things off with spinal trauma alongside CCP Jim Walmsley, discussing decision-making, immobilisation, and the evolving evidence base guiding contemporary practice.

These are conversations packed with practical insights, clinical nuance, and real pearls of wisdom from our guests. Whether you’re early in your career or an experienced clinician, there is huge value in revisiting these fundamentals and reflecting on how they shape your approach to trauma care on scene.

As always, the aim is not to be prescriptive but to support your thinking, challenge assumptions, and broaden your perspective on managing seriously injured patients in the pre-hospital environment.

Do remember to work within your local policies, guidelines, and scope of practice at all times. But we hope that the discussions in this episode help inform your decision-making and ultimately support you in delivering high-quality, patient-centred trauma care when it matters most.

⁠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/⁠