In this episode, Laura Hall addresses the often-overlooked impact of secondary trauma on emergency responders and healthcare professionals, emphasising the need for meaningful mental health support and long-term resilience. Drawing on personal experience, the discussion challenges the effectiveness of traditional debriefing models, highlighting how well-intentioned but poorly designed institutional processes can fail staff working in chronically high-stress environments.

The conversation explores the consequences of this gap in support, including burnout, moral injury, and workforce attrition. To counter these trends, Laura introduces practical, accessible frameworks such as the Stress Continuum and the 3-3-3 Protocol. These tools provide clinicians with a shared language and structure to recognise early warning signs of psychological strain and to intervene before distress escalates.

A key theme is the concept of making green choices, small, proactive decisions that support recovery, regulation, and psychological safety following traumatic incidents. Rather than relying solely on post-incident interventions, the emphasis is on ongoing self-monitoring, peer support, and normalising conversations about mental wellbeing.

Ultimately, this episode calls for a cultural shift within organisations: from reactive, checkbox approaches to mental health, towards environments that prioritise emotional safety, mutual care, and staff retention through structured, evidence-informed support systems. You can read the blog here: https://highadventurehealthcare.substack.com/p/building-resiliency-in-responders

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 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-copeland

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 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_app

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, 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-sickness

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