Making decisions with incomplete information is part of everyday emergency and trauma care. But when the stakes are particularly high, how do you know when you have enough information to act? Waiting too long may cost lives. Acting too soon may put patients, colleagues or yourself at unnecessary risk.For our 300th St Emlyn’s podcast, Iain Beardsell revisits conversations he and Liz Crowe recorded at Tactical Trauma in Sweden. Drawing on interviews with Claire Park, Sean Brayford-Harris, Alice Hutin and Chris Bishop, he explores how clinicians and first responders make difficult decisions under pressure, from major incidents and mass casualty triage to prehospital eCPR and ECMO in trauma.In this podcast:<ul><li>How Claire Park uses the 40–70 rule to explore when we have enough information to act, while recognising the risks of entering potentially dangerous scenes.</li><li>Lessons from the London Bridge terrorist attack about delayed treatment, casualty evacuation and the difficult balance between responder safety and patient survival.</li><li>Why the Ten Second Triage tool was designed without physiological measurements, allowing non-clinical responders to prioritise casualties and deliver immediate lifesaving interventions.</li><li>How simple, familiar frameworks can reduce cognitive load when responders are frightened, overwhelmed or working outside their usual clinical role.</li><li>Why the availability of prehospital extracorporeal CPR (eCPR) does not mean every patient should receive it, and the challenges of explaining decisions not to proceed.</li><li>The value of discussing decisions aloud, seeking colleagues' views and debriefing after difficult cases.</li><li>Why veno-arterial ECMO remains controversial after major trauma, particularly because of anticoagulation and bleeding risks, and how multidisciplinary decision-making can help identify potential candidates.</li></ul> About the contributorsClaire Park is a consultant in prehospital emergency medicine with extensive experience of high-threat incident response. Sean Brayford-Harris is a London Ambulance Service paramedic who helped develop Ten Second Triage. Alice Hutin is an emergency physician working with the prehospital eCPR service in Paris. Chris Bishop is a clinical perfusionist and research fellow investigating VA-ECMO for cardiogenic shock following major trauma.Links and resourcesYou can explore the original conversations and their accompanying St Emlyn’s articles:<ul><li><a href="https://www.stemlynsblog.org/podcast-care-in-the-hot-zone/" rel="noopener noreferrer" target="_blank">Care in the Hot Zone with Claire Park</a></li><li><a href="https://www.stemlynsblog.org/podcast-ten-second-triage/" rel="noopener noreferrer" target="_blank">Ten Second Triage with Sean Brayford-Harris</a></li><li><a href="https://www.stemlynsblog.org/podcast-prehospital-ecpr/" rel="noopener noreferrer" target="_blank">Prehospital eCPR with Alice Hutin</a></li><li><a href="https://www.stemlynsblog.org/podcast-ecmo-trauma/" rel="noopener noreferrer" target="_blank">ECMO in Trauma with Chris Bishop</a></li><li><a href="https://www.england.nhs.uk/publication/clinical-guidelines-for-major-incidents-and-mass-casualty-events/" rel="noopener noreferrer" target="_blank">NHS England: Ten Second Triage tool and major incident guidance</a></li><li><a href="https://www.tacticaltrauma.se/" rel="noopener noreferrer" target="_blank">Tactical Trauma Conference 2026 – Sundsvall, Sweden, 2–4 November 2026.</a></li></ul> More from St Emlyn’sSt Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our <a href="https://www.stemlynsblog.org/" rel="noopener noreferrer" target="_blank">blogs, podcasts and other resources.</a>If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, <a href="https://www.stemlynsblog.org/contact/" rel="noopener noreferrer" target="_blank">we’d love to hear from you.</a>Learning from podcasts?If podcasts form part of your CPD, <a href="https://www.medpodlearn.co.uk/" rel="noopener noreferrer" target="_blank">MedPod Learn</a> helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD.Subscribe to the St Emlyn’s Podcast wherever you get your podcasts.<a href="https://www.tacticaltrauma.se/" rel="noopener noreferrer" target="_blank">Tactical Trauma</a> is an international conference held in Sundsvall, Sweden, bringing together doctors, paramedics, police officers, military medics and rescue services to share experiences of delivering care in challenging and sometimes hostile environments. The programme covers prehospital trauma care, resuscitation, major incidents, tactical medicine and human performance, with a particular emphasis on learning from real-world experience. The next conference takes place on 2–4 November 2026, and these conversations were recorded at the last Tactical Trauma meeting.

Making decisions with incomplete information is part of everyday emergency and trauma care. But when the stakes are particularly high, how do you know when you have enough information to act? Waiting too long may cost lives. Acting too soon may put patients, colleagues or yourself at unnecessary risk. For our 300th St Emlyn’s podcast, Iain Beardsell revisits conversations he and Liz Crowe recorded at Tactical Trauma in Sweden. Drawing on interviews with Claire Park, Sean Brayford-Harris, Alice Hutin and Chris Bishop, he explores how clinicians and first responders make difficult decisions under pressure, from major incidents and mass casualty triage to prehospital eCPR and ECMO in trauma. In this podcast:How Claire Park uses the 40–70 rule to explore when we have enough information to act, while recognising the risks of entering potentially dangerous scenes.Lessons from the London Bridge terrorist attack about delayed treatment, casualty evacuation and the difficult balance between responder safety and patient survival.Why the Ten Second Triage tool was designed without physiological measurements, allowing non-clinical responders to prioritise casualties and deliver immediate lifesaving interventions.How simple, familiar frameworks can reduce cognitive load when responders are frightened, overwhelmed or working outside their usual clinical role.Why the availability of prehospital extracorporeal CPR (eCPR) does not mean every patient should receive it, and the challenges of explaining decisions not to proceed.The value of discussing decisions aloud, seeking colleagues' views and debriefing after difficult cases.Why veno-arterial ECMO remains controversial after major trauma, particularly because of anticoagulation and bleeding risks, and how multidisciplinary decision-making can help identify potential candidates. About the contributors Claire Park is a consultant in prehospital emergency medicine with extensive experience of high-threat incident response. Sean Brayford-Harris is a London Ambulance Service paramedic who helped develop Ten Second Triage. Alice Hutin is an emergency physician working with the prehospital eCPR service in Paris. Chris Bishop is a clinical perfusionist and research fellow investigating VA-ECMO for cardiogenic shock following major trauma. Links and resources You can explore the original conversations and their accompanying St Emlyn’s articles:Care in the Hot Zone with Claire ParkTen Second Triage with Sean Brayford-HarrisPrehospital eCPR with Alice HutinECMO in Trauma with Chris BishopNHS England: Ten Second Triage tool and major incident guidanceTactical Trauma Conference 2026 – Sundsvall, Sweden, 2–4 November 2026. More from St Emlyn’s St Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our blogs, podcasts and other resources. If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, we’d love to hear from you. Learning from podcasts? If podcasts form part of your CPD, MedPod Learn helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD. Subscribe to the St Emlyn’s Podcast wherever you get your podcasts. Tactical Trauma is an international conference held in Sundsvall, Sweden, bringing together doctors, paramedics, police officers, military medics and rescue services to share experiences of delivering care in challenging and sometimes hostile environments. The programme covers prehospital trauma care, resuscitation, major incidents, tactical medicine and human performance, with a particular emphasis on learning from real-world experience. The next conference takes place on 2–4 November 2026, and these conversations were recorded at the last Tactical Trauma meeting.

Making decisions with incomplete information is part of everyday emergency and trauma care. But when the stakes are particularly high, how do you know when you have enough information to act? Waiting too long may cost lives. Acting too soon may put patients, colleagues or yourself at unnecessary risk.For our 300th St Emlyn’s podcast, Iain Beardsell revisits conversations he and Liz Crowe recorded at Tactical Trauma in Sweden. Drawing on interviews with Claire Park, Sean Brayford-Harris, Alice Hutin and Chris Bishop, he explores how clinicians and first responders make difficult decisions under pressure, from major incidents and mass casualty triage to prehospital eCPR and ECMO in trauma.In this podcast:<ul><li>How Claire Park uses the 40–70 rule to explore when we have enough information to act, while recognising the risks of entering potentially dangerous scenes.</li><li>Lessons from the London Bridge terrorist attack about delayed treatment, casualty evacuation and the difficult balance between responder safety and patient survival.</li><li>Why the Ten Second Triage tool was designed without physiological measurements, allowing non-clinical responders to prioritise casualties and deliver immediate lifesaving interventions.</li><li>How simple, familiar frameworks can reduce cognitive load when responders are frightened, overwhelmed or working outside their usual clinical role.</li><li>Why the availability of prehospital extracorporeal CPR (eCPR) does not mean every patient should receive it, and the challenges of explaining decisions not to proceed.</li><li>The value of discussing decisions aloud, seeking colleagues' views and debriefing after difficult cases.</li><li>Why veno-arterial ECMO remains controversial after major trauma, particularly because of anticoagulation and bleeding risks, and how multidisciplinary decision-making can help identify potential candidates.</li></ul> About the contributorsClaire Park is a consultant in prehospital emergency medicine with extensive experience of high-threat incident response. Sean Brayford-Harris is a London Ambulance Service paramedic who helped develop Ten Second Triage. Alice Hutin is an emergency physician working with the prehospital eCPR service in Paris. Chris Bishop is a clinical perfusionist and research fellow investigating VA-ECMO for cardiogenic shock following major trauma.Links and resourcesYou can explore the original conversations and their accompanying St Emlyn’s articles:<ul><li><a href="https://www.stemlynsblog.org/podcast-care-in-the-hot-zone/" rel="noopener noreferrer">Care in the Hot Zone with Claire Park</a></li><li><a href="https://www.stemlynsblog.org/podcast-ten-second-triage/" rel="noopener noreferrer">Ten Second Triage with Sean Brayford-Harris</a></li><li><a href="https://www.stemlynsblog.org/podcast-prehospital-ecpr/" rel="noopener noreferrer">Prehospital eCPR with Alice Hutin</a></li><li><a href="https://www.stemlynsblog.org/podcast-ecmo-trauma/" rel="noopener noreferrer">ECMO in Trauma with Chris Bishop</a></li><li><a href="https://www.england.nhs.uk/publication/clinical-guidelines-for-major-incidents-and-mass-casualty-events/" rel="noopener noreferrer">NHS England: Ten Second Triage tool and major incident guidance</a></li><li><a href="https://www.tacticaltrauma.se/" rel="noopener noreferrer">Tactical Trauma Conference 2026 – Sundsvall, Sweden, 2–4 November 2026.</a></li></ul> More from St Emlyn’sSt Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our <a href="https://www.stemlynsblog.org/" rel="noopener noreferrer">blogs, podcasts and other resources.</a>If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, <a href="https://www.stemlynsblog.org/contact/" rel="noopener noreferrer">we’d love to hear from you.</a>Learning from podcasts?If podcasts form part of your CPD, <a href="https://www.medpodlearn.co.uk/" rel="noopener noreferrer">MedPod Learn</a> helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD.Subscribe to the St Emlyn’s Podcast wherever you get your podcasts.<a href="https://www.tacticaltrauma.se/" rel="noopener noreferrer">Tactical Trauma</a> is an international conference held in Sundsvall, Sweden, bringing together doctors, paramedics, police officers, military medics and rescue services to share experiences of delivering care in challenging and sometimes hostile environments. The programme covers prehospital trauma care, resuscitation, major incidents, tactical medicine and human performance, with a particular emphasis on learning from real-world experience. The next conference takes place on 2–4 November 2026, and these conversations were recorded at the last Tactical Trauma meeting.

Ep 300 - Decisions under pressure from Tactical Trauma

Traumatic cardiac arrest demands rapid treatment, but one of the hardest decisions is whether a resuscitative thoracotomy is likely to help. Can the location of a penetrating injury and the rhythm on the monitor give us better information than an uncertain history of when the patient arrested?Recorded at Trauma 2030 at the Royal College of Surgeons of England, Iain Beardsell speaks with Laura Kocierz about a data-driven approach developed from London’s Air Ambulance experience. They discuss distinguishing cardiac tamponade from exsanguination, using ECG rhythm as a surrogate for arrest duration, and why thoracotomy should target the underlying pathology rather than simply the diagnosis of traumatic cardiac arrest.In this podcast:<ul><li>Why traumatic cardiac arrest is better thought of as a clinical low-output state rather than relying on a simple binary definition.</li><li>How the surface location of a penetrating injury can help estimate whether cardiac tamponade or exsanguination is the more likely cause.</li><li>Why a wound within the cardiac box or epigastrium was associated with more than a 30% chance of isolated tamponade in the London data.</li><li>Why treating presumed exsanguination should not stop the team actively looking for concurrent tamponade, including with ultrasound.</li><li>How the presenting ECG rhythm may provide useful physiological information when the reported duration of traumatic cardiac arrest is uncertain.</li><li>The observed progression from organised sinus rhythm through bradycardia and agonal complexes to asystole as arrest duration increases — and why these are population-derived timings rather than precise clocks for an individual patient.</li><li>Why an organised rhythm in a patient with suspected tamponade may support immediate resuscitative thoracotomy even when the reported arrest time appears prolonged.</li><li>Why resuscitative thoracotomy is not, in itself, a treatment for exsanguination, where haemorrhage control, blood transfusion and rapid movement towards definitive care may need to take priority.</li></ul> About Laura KocierzLaura Kocierz is a consultant in intensive care medicine and anaesthesia in Worcester and a consultant with London’s Air Ambulance. Her work includes research examining how clinical information available at the scene can support decision-making in traumatic cardiac arrest.Timestamps00:00 – Defining traumatic cardiac arrest 02:00 – Injury location, tamponade and exsanguination 05:00 – When should resuscitative thoracotomy be considered? 07:00 – Using the ECG as a surrogate for arrest duration 11:00 – Combining likely pathology with presenting rhythm 13:00 – Moving beyond a simple 15-minute rule 14:00 – Why thoracotomy is not the treatment for exsanguinationLinks and resources<a href="https://pubmed.ncbi.nlm.nih.gov/41233917/" rel="noopener noreferrer" target="_blank">Read the paper: Improving decision-making for prehospital Resuscitative Thoracotomy in traumatic cardiac arrest</a><a href="https://pubmed.ncbi.nlm.nih.gov/40009367/" rel="noopener noreferrer" target="_blank">Read the London’s Air Ambulance study of 601 prehospital resuscitative thoracotomies</a><a href="https://fundraising.londonsairambulance.org.uk/event/trauma-2030/home" rel="noopener noreferrer" target="_blank">Find out more about Trauma 2030</a>More from St Emlyn’sSt Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our <a href="https://www.stemlynsblog.org/" rel="noopener noreferrer" target="_blank">blogs, podcasts and other resources</a>.If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, <a href="https://www.stemlynsblog.org/contact/" rel="noopener noreferrer" target="_blank">we’d love to hear from you</a>.Learning from podcasts?If podcasts form part of your CPD, <a href="https://www.medpodlearn.co.uk/" rel="noopener noreferrer" target="_blank">MedPod Learn</a> helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD.Subscribe to the St Emlyn’s Podcast wherever you get your podcasts.Trauma 2030TRAUMA 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.

Traumatic cardiac arrest demands rapid treatment, but one of the hardest decisions is whether a resuscitative thoracotomy is likely to help. Can the location of a penetrating injury and the rhythm on the monitor give us better information than an uncertain history of when the patient arrested? Recorded at Trauma 2030 at the Royal College of Surgeons of England, Iain Beardsell speaks with Laura Kocierz about a data-driven approach developed from London’s Air Ambulance experience. They discuss distinguishing cardiac tamponade from exsanguination, using ECG rhythm as a surrogate for arrest duration, and why thoracotomy should target the underlying pathology rather than simply the diagnosis of traumatic cardiac arrest. In this podcast:Why traumatic cardiac arrest is better thought of as a clinical low-output state rather than relying on a simple binary definition.How the surface location of a penetrating injury can help estimate whether cardiac tamponade or exsanguination is the more likely cause.Why a wound within the cardiac box or epigastrium was associated with more than a 30% chance of isolated tamponade in the London data.Why treating presumed exsanguination should not stop the team actively looking for concurrent tamponade, including with ultrasound.How the presenting ECG rhythm may provide useful physiological information when the reported duration of traumatic cardiac arrest is uncertain.The observed progression from organised sinus rhythm through bradycardia and agonal complexes to asystole as arrest duration increases — and why these are population-derived timings rather than precise clocks for an individual patient.Why an organised rhythm in a patient with suspected tamponade may support immediate resuscitative thoracotomy even when the reported arrest time appears prolonged.Why resuscitative thoracotomy is not, in itself, a treatment for exsanguination, where haemorrhage control, blood transfusion and rapid movement towards definitive care may need to take priority. About Laura Kocierz Laura Kocierz is a consultant in intensive care medicine and anaesthesia in Worcester and a consultant with London’s Air Ambulance. Her work includes research examining how clinical information available at the scene can support decision-making in traumatic cardiac arrest. Timestamps 00:00 – Defining traumatic cardiac arrest 02:00 – Injury location, tamponade and exsanguination 05:00 – When should resuscitative thoracotomy be considered? 07:00 – Using the ECG as a surrogate for arrest duration 11:00 – Combining likely pathology with presenting rhythm 13:00 – Moving beyond a simple 15-minute rule 14:00 – Why thoracotomy is not the treatment for exsanguination Links and resources Read the paper: Improving decision-making for prehospital Resuscitative Thoracotomy in traumatic cardiac arrest Read the London’s Air Ambulance study of 601 prehospital resuscitative thoracotomies Find out more about Trauma 2030 More from St Emlyn’s St Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our blogs, podcasts and other resources. If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, we’d love to hear from you. Learning from podcasts? If podcasts form part of your CPD, MedPod Learn helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD. Subscribe to the St Emlyn’s Podcast wherever you get your podcasts. 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.

Traumatic cardiac arrest demands rapid treatment, but one of the hardest decisions is whether a resuscitative thoracotomy is likely to help. Can the location of a penetrating injury and the rhythm on the monitor give us better information than an uncertain history of when the patient arrested?Recorded at Trauma 2030 at the Royal College of Surgeons of England, Iain Beardsell speaks with Laura Kocierz about a data-driven approach developed from London’s Air Ambulance experience. They discuss distinguishing cardiac tamponade from exsanguination, using ECG rhythm as a surrogate for arrest duration, and why thoracotomy should target the underlying pathology rather than simply the diagnosis of traumatic cardiac arrest.In this podcast:<ul><li>Why traumatic cardiac arrest is better thought of as a clinical low-output state rather than relying on a simple binary definition.</li><li>How the surface location of a penetrating injury can help estimate whether cardiac tamponade or exsanguination is the more likely cause.</li><li>Why a wound within the cardiac box or epigastrium was associated with more than a 30% chance of isolated tamponade in the London data.</li><li>Why treating presumed exsanguination should not stop the team actively looking for concurrent tamponade, including with ultrasound.</li><li>How the presenting ECG rhythm may provide useful physiological information when the reported duration of traumatic cardiac arrest is uncertain.</li><li>The observed progression from organised sinus rhythm through bradycardia and agonal complexes to asystole as arrest duration increases — and why these are population-derived timings rather than precise clocks for an individual patient.</li><li>Why an organised rhythm in a patient with suspected tamponade may support immediate resuscitative thoracotomy even when the reported arrest time appears prolonged.</li><li>Why resuscitative thoracotomy is not, in itself, a treatment for exsanguination, where haemorrhage control, blood transfusion and rapid movement towards definitive care may need to take priority.</li></ul> About Laura KocierzLaura Kocierz is a consultant in intensive care medicine and anaesthesia in Worcester and a consultant with London’s Air Ambulance. Her work includes research examining how clinical information available at the scene can support decision-making in traumatic cardiac arrest.Timestamps00:00 – Defining traumatic cardiac arrest 02:00 – Injury location, tamponade and exsanguination 05:00 – When should resuscitative thoracotomy be considered? 07:00 – Using the ECG as a surrogate for arrest duration 11:00 – Combining likely pathology with presenting rhythm 13:00 – Moving beyond a simple 15-minute rule 14:00 – Why thoracotomy is not the treatment for exsanguinationLinks and resources<a href="https://pubmed.ncbi.nlm.nih.gov/41233917/" rel="noopener noreferrer">Read the paper: Improving decision-making for prehospital Resuscitative Thoracotomy in traumatic cardiac arrest</a><a href="https://pubmed.ncbi.nlm.nih.gov/40009367/" rel="noopener noreferrer">Read the London’s Air Ambulance study of 601 prehospital resuscitative thoracotomies</a><a href="https://fundraising.londonsairambulance.org.uk/event/trauma-2030/home" rel="noopener noreferrer">Find out more about Trauma 2030</a>More from St Emlyn’sSt Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our <a href="https://www.stemlynsblog.org/" rel="noopener noreferrer">blogs, podcasts and other resources</a>.If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, <a href="https://www.stemlynsblog.org/contact/" rel="noopener noreferrer">we’d love to hear from you</a>.Learning from podcasts?If podcasts form part of your CPD, <a href="https://www.medpodlearn.co.uk/" rel="noopener noreferrer">MedPod Learn</a> helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD.Subscribe to the St Emlyn’s Podcast wherever you get your podcasts.Trauma 2030TRAUMA 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.

Ep 298 - Traumatic Cardiac Arrest: Rethinking Resuscitative Thoracotomy with Laura Kocierz at Trauma 2030

The Fifth Universal Definition of Myocardial Infarction changes some familiar language around MI and puts new emphasis on how we interpret troponin, myocardial injury and imaging. For emergency clinicians, these changes affect both how we describe what is happening and how confidently we can make the diagnosis.Iain Beardsell introduces Rick Body, Professor of Emergency Medicine at the University of Manchester, who works through what has changed and what it means in practice.In this podcast:<ul><li>Why the familiar type 1–5 classification has been replaced by primary, secondary and procedure-related myocardial infarction.</li><li>How conditions including plaque rupture, spontaneous coronary artery dissection, coronary vasospasm and embolism now fit within primary MI.</li><li>Why the definition now supports sex-specific 99th percentile high-sensitivity troponin thresholds, and what this may mean for commonly used assays.</li><li>How coronary or cardiac imaging has become more important when moving from a likely MI diagnosis towards confirmation and defining the underlying mechanism.</li><li>Why a raised troponin is not synonymous with myocardial infarction, and how acute myocardial injury may result from inflammation, haemodynamic stress, physiological stress, catecholamine excess, toxicity or trauma.</li><li>The challenge of diagnosing chronic myocardial injury in the emergency department when the definition describes assessment in a stable clinical setting.</li><li>Why interpreting a troponin delta remains nuanced: absolute versus relative change, time from symptom onset and the interval between samples all matter.</li><li>Where occlusive myocardial infarction (OMI) now sits: the terminology has not replaced STEMI/NSTEMI, but recognised occlusion patterns including de Winter T waves, Wellens syndrome, Sgarbossa criteria and posterior MI are explicitly discussed.</li></ul> About Rick BodyRick Body is Professor of Emergency Medicine at the University of Manchester and an honorary consultant at Manchester Foundation Trust. He is also Editor-in-Chief of the Emergency Medicine Journal and chairs the NICE Interventional Procedures Advisory Committee.Timestamps00:00 – Introduction and why the new definition matters 02:00 – Primary, secondary and procedure-related MI 04:00 – Sex-specific troponin thresholds 05:00 – Imaging and confirmation of myocardial infarction 06:00 – Acute myocardial injury and its causes 09:00 – Chronic myocardial injury in the ED 11:00 – Absolute versus relative troponin deltas 15:00 – OMI, STEMI and NSTEMI terminologyLinks and resources<a href="https://www.stemlynsblog.org/the-fifth-universal-definition-of-myocardial-infarction-what-emergency-clinicians-need-to-know/" rel="noopener noreferrer" target="_blank">Read the accompanying St Emlyn’s article</a><a href="https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag101/8766309" rel="noopener noreferrer" target="_blank">Read the Fifth Universal Definition of Myocardial Infarction</a><a href="https://ifccfiles.com/2026/04/High-Sensitivity-Cardiac-Troponin-I-and-T-Assay-Analytical-Characteristics-Designated-By-Manufacturer-v032026.pdf" rel="noopener noreferrer" target="_blank">View the IFCC high-sensitivity cardiac troponin assay reference tables</a>More from St Emlyn’sSt Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our <a href="https://www.stemlynsblog.org/?utm_source=chatgpt.com" rel="noopener noreferrer" target="_blank">blogs, podcasts and other resources</a>.If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, <a href="https://www.stemlynsblog.org/contact/?utm_source=chatgpt.com" rel="noopener noreferrer" target="_blank">we’d love to hear from you</a>.Learning from podcasts?If podcasts form part of your CPD, <a href="https://www.medpodlearn.co.uk/?utm_source=chatgpt.com" rel="noopener noreferrer" target="_blank">MedPod Learn</a> helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD.

The Fifth Universal Definition of Myocardial Infarction changes some familiar language around MI and puts new emphasis on how we interpret troponin, myocardial injury and imaging. For emergency clinicians, these changes affect both how we describe what is happening and how confidently we can make the diagnosis. Iain Beardsell introduces Rick Body, Professor of Emergency Medicine at the University of Manchester, who works through what has changed and what it means in practice. In this podcast:Why the familiar type 1–5 classification has been replaced by primary, secondary and procedure-related myocardial infarction.How conditions including plaque rupture, spontaneous coronary artery dissection, coronary vasospasm and embolism now fit within primary MI.Why the definition now supports sex-specific 99th percentile high-sensitivity troponin thresholds, and what this may mean for commonly used assays.How coronary or cardiac imaging has become more important when moving from a likely MI diagnosis towards confirmation and defining the underlying mechanism.Why a raised troponin is not synonymous with myocardial infarction, and how acute myocardial injury may result from inflammation, haemodynamic stress, physiological stress, catecholamine excess, toxicity or trauma.The challenge of diagnosing chronic myocardial injury in the emergency department when the definition describes assessment in a stable clinical setting.Why interpreting a troponin delta remains nuanced: absolute versus relative change, time from symptom onset and the interval between samples all matter.Where occlusive myocardial infarction (OMI) now sits: the terminology has not replaced STEMI/NSTEMI, but recognised occlusion patterns including de Winter T waves, Wellens syndrome, Sgarbossa criteria and posterior MI are explicitly discussed. About Rick Body Rick Body is Professor of Emergency Medicine at the University of Manchester and an honorary consultant at Manchester Foundation Trust. He is also Editor-in-Chief of the Emergency Medicine Journal and chairs the NICE Interventional Procedures Advisory Committee. Timestamps 00:00 – Introduction and why the new definition matters 02:00 – Primary, secondary and procedure-related MI 04:00 – Sex-specific troponin thresholds 05:00 – Imaging and confirmation of myocardial infarction 06:00 – Acute myocardial injury and its causes 09:00 – Chronic myocardial injury in the ED 11:00 – Absolute versus relative troponin deltas 15:00 – OMI, STEMI and NSTEMI terminology Links and resources Read the accompanying St Emlyn’s article Read the Fifth Universal Definition of Myocardial Infarction View the IFCC high-sensitivity cardiac troponin assay reference tables More from St Emlyn’s St Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our blogs, podcasts and other resources. If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, we’d love to hear from you. Learning from podcasts? If podcasts form part of your CPD, MedPod Learn helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD.

The Fifth Universal Definition of Myocardial Infarction changes some familiar language around MI and puts new emphasis on how we interpret troponin, myocardial injury and imaging. For emergency clinicians, these changes affect both how we describe what is happening and how confidently we can make the diagnosis.Iain Beardsell introduces Rick Body, Professor of Emergency Medicine at the University of Manchester, who works through what has changed and what it means in practice.In this podcast:<ul><li>Why the familiar type 1–5 classification has been replaced by primary, secondary and procedure-related myocardial infarction.</li><li>How conditions including plaque rupture, spontaneous coronary artery dissection, coronary vasospasm and embolism now fit within primary MI.</li><li>Why the definition now supports sex-specific 99th percentile high-sensitivity troponin thresholds, and what this may mean for commonly used assays.</li><li>How coronary or cardiac imaging has become more important when moving from a likely MI diagnosis towards confirmation and defining the underlying mechanism.</li><li>Why a raised troponin is not synonymous with myocardial infarction, and how acute myocardial injury may result from inflammation, haemodynamic stress, physiological stress, catecholamine excess, toxicity or trauma.</li><li>The challenge of diagnosing chronic myocardial injury in the emergency department when the definition describes assessment in a stable clinical setting.</li><li>Why interpreting a troponin delta remains nuanced: absolute versus relative change, time from symptom onset and the interval between samples all matter.</li><li>Where occlusive myocardial infarction (OMI) now sits: the terminology has not replaced STEMI/NSTEMI, but recognised occlusion patterns including de Winter T waves, Wellens syndrome, Sgarbossa criteria and posterior MI are explicitly discussed.</li></ul> About Rick BodyRick Body is Professor of Emergency Medicine at the University of Manchester and an honorary consultant at Manchester Foundation Trust. He is also Editor-in-Chief of the Emergency Medicine Journal and chairs the NICE Interventional Procedures Advisory Committee.Timestamps00:00 – Introduction and why the new definition matters 02:00 – Primary, secondary and procedure-related MI 04:00 – Sex-specific troponin thresholds 05:00 – Imaging and confirmation of myocardial infarction 06:00 – Acute myocardial injury and its causes 09:00 – Chronic myocardial injury in the ED 11:00 – Absolute versus relative troponin deltas 15:00 – OMI, STEMI and NSTEMI terminologyLinks and resources<a href="https://www.stemlynsblog.org/the-fifth-universal-definition-of-myocardial-infarction-what-emergency-clinicians-need-to-know/" rel="noopener noreferrer">Read the accompanying St Emlyn’s article</a><a href="https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag101/8766309" rel="noopener noreferrer">Read the Fifth Universal Definition of Myocardial Infarction</a><a href="https://ifccfiles.com/2026/04/High-Sensitivity-Cardiac-Troponin-I-and-T-Assay-Analytical-Characteristics-Designated-By-Manufacturer-v032026.pdf" rel="noopener noreferrer">View the IFCC high-sensitivity cardiac troponin assay reference tables</a>More from St Emlyn’sSt Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our <a href="https://www.stemlynsblog.org/?utm_source=chatgpt.com" rel="noopener noreferrer">blogs, podcasts and other resources</a>.If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, <a href="https://www.stemlynsblog.org/contact/?utm_source=chatgpt.com" rel="noopener noreferrer">we’d love to hear from you</a>.Learning from podcasts?If podcasts form part of your CPD, <a href="https://www.medpodlearn.co.uk/?utm_source=chatgpt.com" rel="noopener noreferrer">MedPod Learn</a> helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD.

Ep 297 - The 5th Universal Definition of MI - what emergency clinicians need to know

What separates an expert from someone who simply knows a lot? Sara Crager argues that expertise is less about accumulating facts or hours of experience and more about developing better mental models: structured ways of organising knowledge and approaching difficult problems.Iain Beardsell speaks with Sara about deliberate practice, how experts can make their thinking visible to learners, and Rapid Sequence, the clinical simulation game she developed with Ryan Ernst to let clinicians practise complex decision-making, cognitive load and critical care physiology without putting real patients at risk.In this podcast:<ul><li>Why the familiar idea that expertise comes from simply accumulating 10,000 hours misses the importance of deliberate practice, feedback and progressively refining how you think.</li><li>How mental models allow experts to organise large amounts of knowledge into practical approaches they can use at the bedside.</li><li>Whether expert ways of thinking should be taught earlier in medical education, rather than expecting learners to develop them through experience alone.</li><li>Why teaching the H's and T's of cardiac arrest may be less useful than showing learners how experienced clinicians structure a differential diagnosis around respiratory, haemodynamic and metabolic problems.</li><li>The challenge for experienced clinicians of recognising and explaining what they actually do, rather than simply teaching medicine in the way they themselves were taught.</li><li>How Rapid Sequence combines simulated clinical cases, interruptions, competing priorities and expert debriefing to create a safe environment for repeated practice and failure.</li><li>Why “multitasking” may be better understood as rapid task switching, including deliberately pausing, bookmarking and returning to clinical problems as interruptions occur.</li><li>Why gamification is not intended to replace clinical experience, podcasts, simulation or teaching, but can add another way to practise applying knowledge under realistic cognitive load.</li></ul> About Sara CragerSara Crager is an emergency physician, intensivist and medical educator with a particular interest in making complex critical care physiology understandable and clinically useful. She created <a href="https://www.icuedu.org/" rel="noopener noreferrer" target="_blank">ICUedu</a> and co-developed Rapid Sequence with emergency physician and educator Ryan Ernst.Links and resources<a href="https://www.rapidsequence.org/" rel="noopener noreferrer" target="_blank">Explore Rapid Sequence and play a sample case</a><a href="https://www.icuedu.org/" rel="noopener noreferrer" target="_blank">Visit ICUedu</a>More from St Emlyn’sSt Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our <a href="https://www.stemlynsblog.org/" rel="noopener noreferrer" target="_blank">blogs, podcasts and other resources</a>.If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, <a href="https://www.stemlynsblog.org/contact/" rel="noopener noreferrer" target="_blank">we’d love to hear from you</a>.Learning from podcasts?If podcasts form part of your CPD, <a href="https://www.medpodlearn.co.uk/" rel="noopener noreferrer" target="_blank">MedPod Learn</a> helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD.

What separates an expert from someone who simply knows a lot? Sara Crager argues that expertise is less about accumulating facts or hours of experience and more about developing better mental models: structured ways of organising knowledge and approaching difficult problems. Iain Beardsell speaks with Sara about deliberate practice, how experts can make their thinking visible to learners, and Rapid Sequence, the clinical simulation game she developed with Ryan Ernst to let clinicians practise complex decision-making, cognitive load and critical care physiology without putting real patients at risk. In this podcast:Why the familiar idea that expertise comes from simply accumulating 10,000 hours misses the importance of deliberate practice, feedback and progressively refining how you think.How mental models allow experts to organise large amounts of knowledge into practical approaches they can use at the bedside.Whether expert ways of thinking should be taught earlier in medical education, rather than expecting learners to develop them through experience alone.Why teaching the H's and T's of cardiac arrest may be less useful than showing learners how experienced clinicians structure a differential diagnosis around respiratory, haemodynamic and metabolic problems.The challenge for experienced clinicians of recognising and explaining what they actually do, rather than simply teaching medicine in the way they themselves were taught.How Rapid Sequence combines simulated clinical cases, interruptions, competing priorities and expert debriefing to create a safe environment for repeated practice and failure.Why “multitasking” may be better understood as rapid task switching, including deliberately pausing, bookmarking and returning to clinical problems as interruptions occur.Why gamification is not intended to replace clinical experience, podcasts, simulation or teaching, but can add another way to practise applying knowledge under realistic cognitive load. About Sara Crager Sara Crager is an emergency physician, intensivist and medical educator with a particular interest in making complex critical care physiology understandable and clinically useful. She created ICUedu and co-developed Rapid Sequence with emergency physician and educator Ryan Ernst. Links and resources Explore Rapid Sequence and play a sample case Visit ICUedu More from St Emlyn’s St Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our blogs, podcasts and other resources. If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, we’d love to hear from you. Learning from podcasts? If podcasts form part of your CPD, MedPod Learn helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD.

What separates an expert from someone who simply knows a lot? Sara Crager argues that expertise is less about accumulating facts or hours of experience and more about developing better mental models: structured ways of organising knowledge and approaching difficult problems.Iain Beardsell speaks with Sara about deliberate practice, how experts can make their thinking visible to learners, and Rapid Sequence, the clinical simulation game she developed with Ryan Ernst to let clinicians practise complex decision-making, cognitive load and critical care physiology without putting real patients at risk.In this podcast:<ul><li>Why the familiar idea that expertise comes from simply accumulating 10,000 hours misses the importance of deliberate practice, feedback and progressively refining how you think.</li><li>How mental models allow experts to organise large amounts of knowledge into practical approaches they can use at the bedside.</li><li>Whether expert ways of thinking should be taught earlier in medical education, rather than expecting learners to develop them through experience alone.</li><li>Why teaching the H's and T's of cardiac arrest may be less useful than showing learners how experienced clinicians structure a differential diagnosis around respiratory, haemodynamic and metabolic problems.</li><li>The challenge for experienced clinicians of recognising and explaining what they actually do, rather than simply teaching medicine in the way they themselves were taught.</li><li>How Rapid Sequence combines simulated clinical cases, interruptions, competing priorities and expert debriefing to create a safe environment for repeated practice and failure.</li><li>Why “multitasking” may be better understood as rapid task switching, including deliberately pausing, bookmarking and returning to clinical problems as interruptions occur.</li><li>Why gamification is not intended to replace clinical experience, podcasts, simulation or teaching, but can add another way to practise applying knowledge under realistic cognitive load.</li></ul> About Sara CragerSara Crager is an emergency physician, intensivist and medical educator with a particular interest in making complex critical care physiology understandable and clinically useful. She created <a href="https://www.icuedu.org/" rel="noopener noreferrer">ICUedu</a> and co-developed Rapid Sequence with emergency physician and educator Ryan Ernst.Links and resources<a href="https://www.rapidsequence.org/" rel="noopener noreferrer">Explore Rapid Sequence and play a sample case</a><a href="https://www.icuedu.org/" rel="noopener noreferrer">Visit ICUedu</a>More from St Emlyn’sSt Emlyn’s provides free, evidence-based education for the emergency and acute care community. Explore our <a href="https://www.stemlynsblog.org/" rel="noopener noreferrer">blogs, podcasts and other resources</a>.If you have an idea you would like to share, would like to write with us, or want to get involved with St Emlyn’s, <a href="https://www.stemlynsblog.org/contact/" rel="noopener noreferrer">we’d love to hear from you</a>.Learning from podcasts?If podcasts form part of your CPD, <a href="https://www.medpodlearn.co.uk/" rel="noopener noreferrer">MedPod Learn</a> helps you turn listening into documented learning. You can use it across all your podcasts — not just St Emlyn’s — to record your listening, make notes, answer questions, reflect on what you have learned and create a record of your CPD.

Ep 294 - Experts Are Made, Not Born: Sara Crager on Mental Models and Rapid Sequence

What do we really know about treating refractory ventricular fibrillation? And why are we still waiting to use strategies that might actually work?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. It’s about understanding why defibrillation fails, how vector and energy delivery matter, and when a different approach might improve outcomes.We also discuss:<ul><li>The difference between refractory and recurrent VF — and why it matters</li><li>What DSED and vector change actually do in physiological terms</li><li>Why guidelines have been slow to move despite emerging evidence</li><li>The role of antiarrhythmics, adrenaline, and sequence of care</li><li>Practical considerations for introducing DSED into real systems</li><li>What comes next — from smarter detection to post-arrest recovery</li></ul> This is a conversation grounded in real-world resuscitation. It challenges current practice without overselling the evidence.Key Learning Points<ul><li>Refractory VF (persistent after multiple shocks) and recurrent VF (returns after ROSC) are distinct clinical problems with different implications</li><li>Double sequential external defibrillation (DSED) may improve outcomes in refractory VF by altering current pathways and myocardial depolarisation</li><li>Timing matters — waiting too long to escalate may reduce the chance of success</li><li>Current guidelines remain cautious, reflecting the balance between evidence and implementation risk</li><li>Defibrillation strategy is only one part of a complex system that includes high-quality CPR, drug therapy, and post-resuscitation care</li></ul> Why This MattersCardiac arrest survival remains low.Small improvements in early resuscitation can have large system-wide effects. Understanding when standard care is failing — and what to do next — is where expertise matters.Learning from podcasts?If podcasts form part of your CPD, you can log your listening time across all podcasts on <a href="https://www.medpodlearn.co.uk/" rel="noopener noreferrer" target="_blank">MedPod Learn</a> — 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.

What do we really know about treating refractory ventricular fibrillation? And why are we still waiting to use strategies that might actually work? 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. It’s about understanding why defibrillation fails, how vector and energy delivery matter, and when a different approach might improve outcomes. We also discuss:The difference between refractory and recurrent VF — and why it mattersWhat DSED and vector change actually do in physiological termsWhy guidelines have been slow to move despite emerging evidenceThe role of antiarrhythmics, adrenaline, and sequence of carePractical considerations for introducing DSED into real systemsWhat comes next — from smarter detection to post-arrest recovery This is a conversation grounded in real-world resuscitation. It challenges current practice without overselling the evidence. Key Learning PointsRefractory VF (persistent after multiple shocks) and recurrent VF (returns after ROSC) are distinct clinical problems with different implicationsDouble sequential external defibrillation (DSED) may improve outcomes in refractory VF by altering current pathways and myocardial depolarisationTiming matters — waiting too long to escalate may reduce the chance of successCurrent guidelines remain cautious, reflecting the balance between evidence and implementation riskDefibrillation strategy is only one part of a complex system that includes high-quality CPR, drug therapy, and post-resuscitation care Why This Matters Cardiac arrest survival remains low. Small improvements in early resuscitation can have large system-wide effects. Understanding when standard care is failing — and what to do next — is where expertise matters. 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.

What do we really know about treating refractory ventricular fibrillation? And why are we still waiting to use strategies that might actually work?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. It’s about understanding why defibrillation fails, how vector and energy delivery matter, and when a different approach might improve outcomes.We also discuss:<ul><li>The difference between refractory and recurrent VF — and why it matters</li><li>What DSED and vector change actually do in physiological terms</li><li>Why guidelines have been slow to move despite emerging evidence</li><li>The role of antiarrhythmics, adrenaline, and sequence of care</li><li>Practical considerations for introducing DSED into real systems</li><li>What comes next — from smarter detection to post-arrest recovery</li></ul> This is a conversation grounded in real-world resuscitation. It challenges current practice without overselling the evidence.Key Learning Points<ul><li>Refractory VF (persistent after multiple shocks) and recurrent VF (returns after ROSC) are distinct clinical problems with different implications</li><li>Double sequential external defibrillation (DSED) may improve outcomes in refractory VF by altering current pathways and myocardial depolarisation</li><li>Timing matters — waiting too long to escalate may reduce the chance of success</li><li>Current guidelines remain cautious, reflecting the balance between evidence and implementation risk</li><li>Defibrillation strategy is only one part of a complex system that includes high-quality CPR, drug therapy, and post-resuscitation care</li></ul> Why This MattersCardiac arrest survival remains low.Small improvements in early resuscitation can have large system-wide effects. Understanding when standard care is failing — and what to do next — is where expertise matters.Learning from podcasts?If podcasts form part of your CPD, you can log your listening time across all podcasts on <a href="https://www.medpodlearn.co.uk/" rel="noopener noreferrer">MedPod Learn</a> — 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.

Ep 289 - Refractory VF, Double Sequential Defibrillation, and the Future of Cardiac Arrest

This week Simon, Dan and Rick discuss a great BET from Hong Kong. Should we routinely CT our major trauma patients from vertex to symphysis?? We think so, but what's the evidence. Giles and Scott from Hong Kong have written the BET that gives us an answer. Read the BET here http://www.bestbets.org/bets/bet.php?id=1779 and then listen to the podcast. S

BestBets - Whole-body CT In trauma patients

A UK based Emergency Medicine podcast for anyone who works in emergency care. The St Emlyn ’s team are all passionate educators and clinicians who strive to bring you the best evidence based education.

Our four pillars of learning are evidence-based medicine, clinical excellence, personal development and the philosophical overview of emergency care. We have a strong academic faculty and reputation for high quality education presented through multimedia platforms and articles.

St Emlyn’s is a name given to a fictionalised emergency care system. This online clinical space is designed to allow clinical care to be discussed without compromising the safety or confidentiality of patients or clinicians.

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A UK based Emergency Medicine podcast for anyone who works in emergency care. The St Emlyn ’s team are all passionate educators and clinicians who strive to bring you the best evidence based education. Our four pillars of learning are evidence-based medicine, clinical excellence, personal development and the philosophical overview of emergency care. We have a strong academic faculty and reputation for high quality education presented through multimedia platforms and articles. St Emlyn’s is a name given to a fictionalised emergency care system. This online clinical space is designed to allow clinical care to be discussed without compromising the safety or confidentiality of patients or clinicians.

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