The St.Emlyn’s Podcast

Winter pressure doesn’t just affect patient flow.

It affects people.

This second episode in the Best Bits of 2025 series focuses on the human side of emergency medicine: culture, moral injury, compassion, and the small but meaningful behaviours that help clinicians stay grounded when work is relentless.

The clips in this episode are drawn from full St Emlyn’s podcast episodes released during 2025 and reflect some of the most thoughtful conversations of the year.

In this episode, we explore:

• What a genuine learning culture looks like on shift — and why it matters more than workload
• Moral injury in emergency and prehospital care, and how it differs from day-to-day moral distress
• Compassionate resuscitation and “the pause” after a death
• Why small, practical actions can counter hopelessness, even when systems are broken
• The EPICC framework and the role of self-compassion in clinical practice

This episode is designed for listening on shift, on the way home, or during a quieter moment over Christmas and New Year.

Featured episodes

Clips in this episode are taken from the following full St Emlyn’s episodes:

• Episode 256 — Monthly Update (November 2024): Learning culture in emergency medicine
• Episode 261 — Moral Injury with Caroline Leech (recorded at Tactical Trauma 24)
• Episode 258 — Compassionate Resuscitation with Matt Hooper (London Trauma Conference)
• Episode 264 — High Performance Teams with Dan Dworkis (Tactical Trauma 24)
• Episode 271 — Monthly Update (April and May 2025): EPICC and self-compassion

All full episodes are available in the podcast feed.

About MedPod Learn

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

Available on the App Store and Google Play.

Emergency medicine strips decision-making back to its essentials when departments are full and time is short.

This first episode in the Best Bits of 2025 series brings together some of the most practically useful moments from the St Emlyn’s podcast this year — focusing on how clinicians make good decisions under pressure, when conditions are far from ideal.

Each clip comes from a full episode released in 2025.

In this episode, we explore:

• How ten-second triage is designed to work on “worst-day” scenarios, not in textbooks
• The uncomfortable truth about why procedures sometimes get done — and why that matters
• Why time, not technique, is often the limiting factor in resuscitative thoracotomy
• The case for earlier invasive monitoring in the sickest patients
• Where thinking around double sequential defibrillation may be heading

This episode is designed to be useful on shift, in the car, or during a quiet moment before the next job.

Featured episodes

Clips in this episode are taken from the following full St Emlyn’s episodes:

• Episode 257 — Ten Second Triage with Sean Brayford-Harris (Tactical Trauma 24)
• Episode 269 — Monthly Round Up (January 2025): Decision-making and prehospital RSI
• Episode 270 — Insights on Cannabis Edibles, Pre-Hospital Thoracotomy and more
• Episode 266 — Monthly Round Up (February 2025): Targeted resuscitation and arterial lines
• Episode 268 — Top Papers of 2024 from The Big Sick Conference

All full episodes are available in the podcast feed.

About MedPod Learn

MedPod Learn is a clinician-built medical podcast player designed to turn listening into structured learning, with optional MCQs, reflection prompts, and saved activity for appraisal and CPD.

You can find it on the App Store and Google Play.

Join Iain Beardsell and Hutch as they review key insights from the Trauma 2030 conference hosted by the Institute of Pre-Hospital Care, part of London's Air Ambulance.

The discussion highlights the emphasis on speed in damage control resuscitation, the ongoing debate on 'scoop and run' versus 'stay and play' approaches, and the nuanced use of resuscitative thoracotomy.

The episode delves into advanced therapies like ECMO, their expanding role in trauma care, and the importance of relentless self-evaluation in medical practice.

Discover how London's focused approach can provide broader lessons for trauma care and the potential for innovative treatments to become more widespread.

Look out for more podcasts from Trauma 2030 over the coming weeks, where we will talk about team leadership in pre-hospital teams, more on damage-control pre-hospital care, nuancing the management of traumatic cardiac arrest, the increasing use of ECMO, and the shocked trauma patient.

The Institute of Pre-Hospital Care

The Institute of Pre-Hospital Care is part of London’s Air Ambulance Charity, focused on advancing pre-hospital care. They train clinicians, use case studies to guide our priorities, develop new clinical interventions and conduct research. They are also proud to educate and inspire the next generation of pre-hospital care experts through our two degree programmes, co-convened with Queen Mary University London (QMUL).

Through the training and education of The Institute of Pre-Hospital Care, they ensure their unique team of doctors and paramedics are there for London, today, tomorrow, always.

Listen on MedPod Learn

MedPod Learn is a new app that turns medical podcasts into structured learning.

Alongside the audio, you get concise learning points, exam-style MCQs, and short reflection prompts — with listening time and activity logged automatically for CPD and appraisal.

If you already learn through podcasts, this is a way to make that learning count.

Available now on iOS and Android.

Recorded at the BASICS Conference 2025, Iain talks with Haldon “Hutch” Hutchinson-Basley about the idea of a “cognitive HALO” — those rare moments where your mental bandwidth hits maximum power.

Hutch describes a traumatic cardiac arrest he encountered alone, with no warning and no crewmate to share the load. He explains how he recognised cognitive overload and used simple strategies — “lighting a flare”, “norming the abnormal”, and dropping tasks he couldn’t safely achieve — to regain decision-making space.

The discussion links this experience to his work on the ATACC course and the emerging SPEAR programme, exploring how realistic, human-centred simulation prepares clinicians to function when the stakes and stress are highest.

MedPod Learn turns trusted FOAMed podcasts into structured CPD, adding concise learning notes, single-best-answer questions, and role-specific reflection prompts to thousands of episodes. Everything you do — listening time, MCQs, reflections — is saved automatically and downloadable in one click for appraisal. The app is free to download, with a one-month trial of the full learning tools. Just search MedPod Learn on the App Store or Google Play.

In this St Emlyn’s podcast, Ian Beardsell and Simon Carley speak with RAF GP Phil Lucas from the Royal Air Force Centre of Aerospace Medicine at the BASICS conference in Leicestershire. They explore what really happens when a pilot pulls the ejection handle, and what this means for pre-hospital and Emergency Department teams who may be the first to see an ejectee.

Phil explains:

• Why the aviation environment is so hostile to humans and how aerospace medicine supports aircrew

• How modern ejection seats work – from canopy jettison and rocket firing to parachute deployment and landing

• The decision making required to eject in a matter of seconds, and how pilots are trained to be “mentally ready”

• Typical injury patterns after ejection, how technology has reduced spinal compression injuries, and where the remaining risks lie

• Practical considerations for ED and pre-hospital teams when a pilot presents after ejection, including spinal precautions and safe removal of flight equipment

• The psychological impact of surviving a crash or ejection, how support needs can change over months, and what helps people return to flying

• Aviation medicine as a career path, including the role of the RAF Centre of Aerospace Medicine, the diploma in aviation medicine, and how this can sit alongside general practice or emergency care

This conversation draws strong parallels between aviation and emergency medicine: human factors, training under pressure, using simulation and mental rehearsal, and the importance of honest, individualised psychological support after critical incidents.

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Simon Carley review blog posts from August and September. They reflect on their experience at the BASICs Conference, highlighting discussions on resuscitation science and new resuscitation council guidelines.

Topics covered include the physiological-targeted resuscitation, arterial line placements during cardiac arrest, the PECan abdominal trauma rule in pediatric emergency care, intra-arrest stellate ganglion blocks, hydrofluoric acid burns treatment, and pediatric status epilepticus. They also delve into the evidence trial on moving patients with refractory out-of-hospital cardiac arrest to hospitals for specialised care, and review discussions on moral injury among emergency responders. Additionally, they mention the upcoming Geckos Global Health and Emergency Care Research Summit and explore the potential future of emergency medicine by 2038.

00:00 Introduction and Conference Highlights

02:55 Arterial Line Placement During Cardiac Arrest

05:27 Pediatric Abdominal Trauma Rule

10:25 Intra-Arrest Stellate Ganglion Blocks

14:35 Moral Injury in Emergency Responders

23:22 Hydrofluoric Acid Burns Treatment

25:38 Ketamine for Pediatric Status Epilepticus

28:57 Refractory Out-of-Hospital Cardiac Arrest

33:59 Global Health and Emergency Care Research

35:09 Conclusion and Future Episodes

Episode summary

• Why in‑person conferences still matter in a post‑COVID world.
• What formats work now: short talks, interviews, demos, strong hosting.
• How to turn “a great day out” into Monday‑morning change.

Guests

• David Carr — EM physician (Toronto). Leads the Annual Update in EM at Whistler. Focus: inclusive, high‑energy, “hard‑core EM” content.
• Haney Mallemat — EM & Critical Care (South Jersey/Philadelphia). Founder of ResusX; designs short, high‑engagement sessions that feel like live conversations.

Key themes

• Why travel when content is online?
• Being in the room changes attention, reflection, and recall. Learning happens in corridors, evening sessions, and next‑day conversations.
• From lectures to experiences.
• Shift to shorter talks, couch discussions, live demos, and deliberate hosting. Format follows audience and venue.
• Programme design starts with the audience.
• Build for how people learn now. Coach faculty. Pick speakers for delivery and credibility.
• Strong hosting is part of pedagogy.
• Good chairs manage flow, time, and psychological safety so the audience can relax and learn.
• Social learning drives change.
• Purposeful social time and small‑group evening sessions create the “stickiness” that leads to projects and practice updates.

Practical takeaways for clinicians

• Arrive with intent: bring 1–2 real patient problems to solve.
• Choose your format: prioritise short talks, interviews, and hands‑on if your attention is fragmented.
• Make it stick on Monday: debrief with a colleague, write one practice change, set a review date. Present a short “what I learned” to your team.
• Borrow authority wisely: take clear, referenced points (e.g., contrast allergy/nephropathy policies) back to local committees.

Practical takeaways for organisers

• Audience first: define who you serve; let that drive length, tone, and format.
• Shorten and vary: fewer bullet‑heavy lectures; more interviews, panels, and no‑slide formats when it helps educators shine.
• Coach and curate: select speakers for content and delivery; build a pipeline for new voices.
• Invest in hosting: treat chairs as educators; they safeguard pacing, transitions, and safety.
• Design the socials: plan purposeful evening micro‑teaching and cross‑disciplinary meet‑ups.
• Measure impact: mandate feedback tied to CPD; analyse themes and close the loop next year.

Risks and tensions

• Edutainment vs evidence: keep the energy without losing rigour.
• Access and equity: budgets, visas, disability, and caring responsibilities exclude many; amplify content post‑event.
• “Too innovative?” Novel formats can struggle with recognition and funding; meet audiences halfway and iterate.

How conferences translate to patient care

• Prioritise topics that solve common bottlenecks.
• Put change agents on stage with take‑home resources (e.g., clear radiology guidance on contrast “allergy” and nephropathy).
• Encourage attendees to form local groups to implement one change within two weeks.

Recorded at the BASICS Pre-Hospital Care Conference at Sketchley Grange, this episode explores one of the most experimental tools in civilian trauma care — the abdominal aortic and junctional tourniquet. Dr Ed Barnard joins us to discuss why this device was developed, how it works, and where it might — just might — save lives when all other options have failed.

The conversation traces the problem of non-compressible haemorrhage, the leading cause of potentially survivable trauma death. Conventional limb tourniquets, pelvic binders and packing can’t reach these deep bleeding sites. The AAJT offers a radical alternative: external aortic compression to buy a few crucial minutes until surgical control or REBOA is possible.

Ed explains the mechanism — an inflatable, ratcheted belt that can occlude the aorta or major junctional vessels — and the evidence so far. Laboratory and volunteer data show that it can stop flow, but pain and tissue ischaemia make it difficult to tolerate for long. Clinical experience remains limited to small case series, mostly in military or research settings, and no human trials yet demonstrate a survival benefit.

The discussion is candid about risk and realism. The AAJT is a last-resort device, to be used only within strict governance, with clear time limits and immediate plans for definitive haemorrhage control. It’s not something you reach for on a normal shift — it’s something you might need once in a career, and only if every other option has failed.

Ed shares insights from ongoing research, including its potential role as a bridge to REBOA, and the governance frameworks that should surround any trial use. The episode ends with a look to the future: how civilian and military collaboration might refine indications, training, and data collection for this rare but potentially life-saving intervention.

Surgeon Captain Ed Barnard

Surgeon Captain Ed Barnard is a Consultant in Emergency Medicine at Addenbrooke’s Hospital, Cambridge, and a Professor of Emergency Medicine with the Defence Medical Services. He also serves with East Anglian Air Ambulance as a HEMS doctor (having had many years as a BASICS responder). His academic work focuses on prehospital and military trauma care, with a portfolio spanning clinical trials, blood product innovation, and trauma system development.

Ed’s academic work focuses on improving survival from catastrophic bleeding, particularly non-compressible and junctional haemorrhage. He has published and presented widely on trauma resuscitation, traumatic cardiac arrest, and the evolving role of devices such as the abdominal aortic and junctional tourniquet (AAJT) and REBOA. He is a co-author of the 2025 BMJ Military Health systematic review examining the utility of the AAJT-S in military practice.

He is also an experienced educator, contributing to trauma training for BASICS, HEMS, and Defence Medical Services, and continues to combine clinical work with research aimed at translating lessons from military to civilian trauma care.

About BASICS:

The British Association for Immediate Care (BASICS) is a UK charity uniting clinicians dedicated to pre-hospital emergency medicine. Founded in 1977, it supports regional immediate-care schemes, delivers national training, and hosts the annual BASICS Pre-Hospital Care Conference, bringing together experts in trauma, retrieval, and critical care — like this conversation with Dr Ed Barnard.

In this episode of the St Emlyn's Podcast, Iain and Simon discuss the latest updates in emergency medicine during the hot UK summer. They discuss the latest research and content from the St Emlyns blog, touching on topics like serotonin syndrome, the impact of the new urgent and emergency care plan in the UK, and the use of salbutamol as an analgesic for renal colic.

They also highlight the growing issue of nitazenes, a new class of synthetic opioids, and their implications for emergency medicine. Lastly, they emphasise the importance of staying updated on toxicology to effectively manage high-acuity, low-occurrence events such as drug-induced hyperthermia.

00:00 Introduction

01:35 Upcoming Conferences

03:41 Med Pod Learn

05:09 Serotonin Syndrome Deep Dive

10:22 Urgent and Emergency Care Plan

18:04 Salbutamol for Renal Colic

22:07 Hypothermia in Toxicology Emergencies

27:04 Nitazines: A Growing Problem

Iain and Simon return after a brief hiatus to discuss key blog posts from April and May on the St Emlyn's Podcast. They highlight notable conferences including IncrEMentum 2025 in Spain, The Big Sick in Zermatt, and the BASICs Conference.

Discussions cover content from recent emergency medicine research, the importance of compassion and patient-centred care, and operational strategies to avoid emergency department overcrowding. Insights are also shared from fieldwork in South Africa on emergency thoracotomies and their impressive survival rates.