What does it really mean to become an expert in resuscitation and critical care?

It is tempting to think that expertise comes from accumulating enough facts, passing enough exams or simply spending 10,000 hours at work. In this episode, Iain Beardsell is joined by emergency physician, intensivist and medical educator Sara Crager to explore why expertise is less about how much we know and more about how we think.

Sara explains how experts develop high-quality mental models that allow them to organise information, recognise patterns and approach difficult clinical problems. Crucially, these mental models do not have to remain hidden inside the heads of experienced clinicians: they can be identified, explained and deliberately taught.

The conversation moves from the limitations of mnemonics and assessment-driven education to the value of deliberate practice, feedback and safe failure. Sara describes how an expert might organise the differential diagnosis of cardiac arrest into respiratory, haemodynamic and metabolic problems, rather than relying solely on a memorised list of Hs and Ts.

Iain and Sara then discuss Rapid Sequence, the gamified clinical-learning platform Sara created with emergency physician Ryan Ernst. Learners work through realistic cases in a simulated clinical environment, managing several patients while dealing with interruptions, competing priorities and the consequences of their decisions.

After each block, Sara and Ryan deconstruct the cases, make their clinical reasoning explicit and introduce mental models that learners can immediately apply when they try again. It is a cycle of practice, failure, teaching and repetition—without putting a real patient at risk.

They also explore why attention, storytelling and visual design matter in medical education; how “multitasking” may be better understood as rapid task switching; and what Sara has learned from turning an educational passion project into a working product.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

In this episode of the St Emlyn’s Podcast, Iain Beardsell and Simon Carley catch up on the February blog posts, recorded in the rather unseasonal context of a UK heatwave. They begin with congratulations to Simon on his reappointment as Dean of the Royal College of Emergency Medicine, before reflecting on recent conferences including IFEM in Hamburg and Don’t Forget The Bubbles in Glasgow.

The clinical focus this month is trauma team leadership, with practical tips on interpreting trauma CT reports, maintaining momentum after the scan, performing safer log rolls, and making feedback more useful for learners and colleagues.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

In this episode of the St Emlyn’s Podcast, Iain Beardsell speaks with Anna Dobbie, consultant in emergency medicine and pre-hospital care, and Clinical Lead for London HEMS.

Recorded at Trauma 2030 at the Royal College of Surgeons in London, the conversation explores what it means to lead exceptional teams in one of the most high-pressure areas of emergency medicine. Anna reflects on six years as Clinical Lead for London HEMS, sharing lessons on leadership, culture, psychological safety, difficult conversations, managing strong personalities, and supporting clinicians to do their best work.

The discussion also touches on the unique nature of pre-hospital care, where teams move rapidly between downtime and high-intensity clinical decision-making, and where trust, openness and mutual respect are essential. Anna describes the importance of making sure all voices are heard, not just the loudest, and explains why leaders need to be consistent, approachable and willing to have honest conversations when things do not go as well as they should.

Anna also reflects on learning leadership on the job, the value of formal leadership training, the challenge of maintaining boundaries when you care deeply about a service, and the relationship between London’s Air Ambulance and its supporting charity.

Finally, Iain and Anna look ahead to the future of trauma care and pre-hospital medicine, including research, ECMO, marginal gains, quality improvement, and the continuing ambition to reduce preventable deaths from trauma.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

Trauma 2030

TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.

In this episode, Iain and Simon catch up on the papers, posts, and conversations that have been sitting with us since the start of the year. Some are familiar. Some are uncomfortable. All of them feel relevant on shift.

We start with the RSI trial — ketamine versus etomidate. A study that generated a lot of noise, and perhaps more certainty than it deserved.

We move through trauma team leadership. Not as a checklist, but as a set of decisions made under pressure — when to call a Code Red, how to structure a handover, and what it means to lead a team that hasn’t worked together before.

There’s a discussion about trauma units. Not the big centres. The places where most patients go. Fewer resources. Different pressures. The same expectations.

We talk about spinal cord injury and blood pressure targets. Numbers are useful. But they’re still just numbers.

And then corridor care. Not a new problem. But one we may have started to accept in ways that should make us uneasy.

We discuss:

• What the RSI trial actually showed — and what it didn’t

This is not a guideline episode. It’s a conversation about practice. About judgement. About the small decisions that shape outcomes long before the data catches up.

If you’re listening after a shift, you’ll recognise most of it.

If podcasts are part of how you learn, you can log your listening, reflect, and build CPD through MedPod Learn. It works across podcasts, not just this one.

As always, thanks for listening.

these ideas are tested in practice.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

Shock is one of the most used words in emergency medicine. It’s also one of the most misunderstood.

In this episode, recorded at Trauma 2030 at the Royal College of Surgeons, I sit down with one of St Emlyn's own, Rich Carden — former emergency physician, now intensive care trainee and PhD graduate in trauma sciences — to explore what shock actually means beyond the blood pressure reading.

We discuss:

• Why shock is fundamentally about oxygen delivery and utilisation at a cellular level

This is not a protocol episode. It’s a physiology conversation. A systems conversation.

If you’re interested in pre-hospital and trauma systems thinking, do take a look at Tactical Trauma — spaces where these ideas are tested in practice.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

Trauma 2030

TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.

As always, thanks for listening.

What do we really know about treating refractory ventricular fibrillation?

In this episode, we talk to Sheldon Cheskes about the evolving science of cardiac arrest, with a focus on refractory and recurrent ventricular fibrillation. We explore the evidence behind double sequential external defibrillation (DSED), how it compares to standard defibrillation, and what the DOSE VF trial has changed in practice.

This is not just about adding another shock.

We also discuss:

The difference between refractory and recurrent VF — and why it matters

What DSED and vector change actually do in physiological terms

Why guidelines have been slow to move despite emerging evidence

The role of antiarrhythmics, adrenaline, and sequence of care

Practical considerations for introducing DSED into real systems

What comes next — from smarter detection to post-arrest recovery

This is a conversation grounded in real-world resuscitation.

Refractory VF (persistent after multiple shocks) and recurrent VF (returns after ROSC) are distinct clinical problems with different implications

Double sequential external defibrillation (DSED) may improve outcomes in refractory VF by altering current pathways and myocardial depolarisation

Timing matters — waiting too long to escalate may reduce the chance of success

Current guidelines remain cautious, reflecting the balance between evidence and implementation risk

Defibrillation strategy is only one part of a complex system that includes high-quality CPR, drug therapy, and post-resuscitation care

Cardiac arrest survival remains low.

Small improvements in early resuscitation can have large system-wide effects.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection.

The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. If you are already listening, you may as well make it count.

You’re about to hear a conversation that ranges widely — from training reform and trauma leadership to ondansetron, paracetamol protocols, and artificial intelligence.

But it isn’t really about any single topic - It’s about where emergency medicine is heading. And whether we are ready for it.

This is our November and December 2025 round-up, and revisits the blog posts from the end of last year. A pause. A reset. A chance to look again at ideas that still matter on shift.

We explore

What this means for trainers, medical schools, and the future of clinical judgement

This episode closes Season 12 of the St Emlyn’s podcast. Season 13 is coming — including London 2030 content and more from recent conferences.

Upcoming events

Tactical Trauma returns 2–4 November in Sundsvall, Sweden. It remains one of the most focused and practical trauma meetings in Europe — small faculty, serious discussion, no fluff. If you are interested in pre-hospital and in-hospital trauma care, it is worth your time.

IncrEMentuM is approaching fast, with limited places remaining. If you’ve heard us talk about it before, you’ll know why people come back.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection.

The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. If you are already listening, you may as well make it count.

More conversations from recent meetings — including Trauma 2030 — will follow in upcoming episodes.

Thanks for listening

You’re about to hear a conversation about doing less. But it isn’t really about doing less. It’s about time.

Recorded at Trauma 2030 at the Royal College of Surgeons, this episode explores a shift in mindset in pre-hospital trauma care — away from maximal intervention on scene and towards rapid recognition of the patient who cannot be fixed pre-hospital.

I’m joined by Harriet Tucker — consultant at London’s Air Ambulance, HEMS Governance Lead at Air Ambulance Kent Surrey Sussex, and Trauma Team Leader at St George’s Major Trauma Centre — to talk about damage control pre-hospital care.

We discuss:

Using time as a treatment

Recognising non-compressible haemorrhage

Why one line may be enough

Moving interventions into the ambulance

Changing the pre-alert

The “pit stop” resus

Taking patients straight to theatre

Cultural resistance to doing less

Governance, debrief, and looking after teams

This approach focuses on a small but critically unwell group of patients — often penetrating trauma with rapidly exsanguinating haemorrhage — where the only definitive treatment is surgical control of bleeding.

The key intervention is speed.

Harriet also discusses the governance work behind this change, the importance of reviewing every case, and how to bring ambulance services and in-hospital teams along with the shift in thinking.

This episode is part of a series recorded at Trauma 2030. More conversations from the meeting will follow in upcoming episodes. 

Upcoming events

Harriet will be speaking at Tactical Trauma, 2–4 November, Sundsvall, Sweden.

IncrEMentuM is now only eight weeks away, with limited tickets remaining.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

Trauma 2030

TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.

In this episode of the St Emlyn’s Podcast, we’re joined by Nigel Ruddell, Medical Director of the Northern Ireland Ambulance Service, recorded live at the BASICS Conference.

This is a conversation about Helicopter Emergency Medical Services (HEMS) — but not in the way you might expect.

It’s not really about aircraft. It’s about people.

Nigel talks us through the long, often uncomfortable journey to building Air Ambulance Northern Ireland. From early fundraising attempts in the 2000s, through the influence and legacy of Dr John Hinds, to the eventual partnership between charity and the statutory ambulance service that made a doctor–paramedic HEMS model possible.

We explore:

• Why the helicopter isn’t the intervention — the team is

We also reflect on John Hinds's legacy and how his passion catalysed change, including the significance of the Delta 7 callsign.

This is a thoughtful conversation about system design, pre-hospital care, and what it actually takes to introduce enhanced critical care capability into a region that has never had it before.

If you enjoy thinking about pre-hospital medicine, trauma systems, and the future of emergency care, you may also want to look at: the IncrEMentuM Conference and Tactical Trauma

And if you want to go deeper into the evidence behind the conversations we have on this podcast, explore MedPod Learn — now hosting nearly 5,000 medical podcast episodes with linked multiple-choice questions to support structured learning.

As always, thanks for listening.

In this episode of the St Emlyn’s Podcast, Iain Beardsell and Simon Carley talk with Caroline Leech at the BASICs Conference about resuscitative hysterotomy following maternal cardiac arrest.

This is a calm, evidence-led discussion of a rare, high-stakes intervention that most clinicians will encounter once, if at all — and still need to get right.

Why the term resuscitative hysterotomy has replaced perimortem caesarean section

The physiological rationale: relieving aortocaval compression to improve maternal resuscitation

What the evidence actually shows about timing, maternal survival, and neonatal outcomes

Findings from Caroline’s systematic review of out-of-hospital cardiac arrest in pregnancy

Why the “4–5 minute rule” does not reflect real-world pre-hospital care

Neonatal survival at far longer timelines than traditionally taught

Practical decision-making in pre-hospital and emergency department settings

Who should perform the procedure, and why speed matters more than seniority

Aftercare challenges: open abdomen, placenta management, bleeding (or lack of it)

Team cognitive load, role allocation, and when termination at scene is appropriate

The emotional and professional impact on clinicians and families

Maternal survival after out-of-hospital arrest is rare, but not zero

Neonatal survival is higher than often appreciated, even with prolonged timelines

Delaying purely to reach hospital or a specialist may reduce benefit

The hardest part is not the incision — it is the decision, coordination, and aftermath

Training should focus as much on judgement and communication as on technical skill

This episode is not about heroics.

MedPod Learn is a medical podcast player designed to help turn listening into structured learning, with tools to support reflection, CPD, and appraisal.

IncrEMentuM was born to revolutionise how we approach emergency medicine. It’s not a traditional conference — it’s an immersive experience that pushes professionals to act, think, and make decisions in real time.

Our mission is to bring together healthcare providers, experts, and emergency personnel from around the world to share experiences, train in realistic scenarios, and test their skills under extreme pressure.

In 2026, we return with an even more intense and lifelike edition — all with one clear goal: to prepare you for what cannot be predicted.

This is an international conference covering various aspects of working in high-stakes environments, primarily related to pre-hospital trauma and critical care, with a tactical twist.

Our program is rich and diverse, featuring state-of-the-art lectures from world-class speakers. We aim to bring together all organisations working with pre-hospital trauma in tactical/hostile environments, including physicians, HEMS, EMS, police anti-terror units, military, fire and rescue services and more.