The St.Emlyn’s Podcast

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• The difference between pressure and perfusion• The concept of the “dose” of shock — magnitude and duration• Why haemorrhage may only be the first phase• How trauma patients transition between haemorrhagic, inflammatory, vasoplegic and septic states• The glycocalyx — and why losing it matters• The risks of early vasopressors in an empty system• Why doing the basics exceptionally well remains our best intervention This is not a protocol episode. It’s a physiology conversation. A systems conversation.A reminder that restoring a number is not the same as restoring oxygen to mitochondria. 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.

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 The Medical Education Training Review and what it might mean for emergency medicine in the UK Flexibility, bottlenecks, and the portfolio route Why culture and team matter more than workload alone Trauma Team Leader tips — from missed wounds to managing presence in the room Ondansetron in paediatric gastroenteritis — symptom control or over-medicalisation? The SNAP protocol for paracetamol overdose in children How long it can take for good data to become everyday practice AI in the consultation room — and what happens when patients arrive with ChatGPT 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

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• The charity–NHS partnership model in Northern Ireland• Geography, rurality, and the realities of serving 1.9 million people• Dispatch challenges and the use of video triage (including the GoodSAM platform)• Cross-border working with the National Ambulance Service of Ireland• The cultural work required to convince colleagues that HEMS is not a “Cinderella service”• Humility, leadership, and the people who quietly build systems 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 (rather delayed!) October round-up, Iain Beardsell and Simon Carley catch up on recent St Emlyn’s blog posts and papers that continue to shape emergency and resuscitation practice. The discussion moves across trauma, analgesia, cardiac arrest physiology, emergency department systems, and antimicrobial stewardship—less about novelty, more about what actually holds up on shift. Trauma and haemorrhage The episode opens with a discussion of the FIRST-2 trial, examining fibrinogen concentrate and prothrombin complex concentrate versus fresh frozen plasma in severe traumatic haemorrhage.Despite promising physiological theory, the trial shows no meaningful reduction in blood product use compared with standard care, reinforcing the ongoing role of FFP in early trauma resuscitation. Upper limb injuries and regional anaesthesia The team explore the SUPERB trial comparing supraclavicular brachial plexus blocks with Bier’s blocks for upper limb reductions.Both techniques provide excellent analgesia. The conversation reflects on changing practice, procedural sedation pressures, ultrasound access, and how physical space—not evidence—often dictates what we do. Cardiac arrest: signals worth paying attention to Three recent cardiac arrest papers are reviewed, focusing on physiological markers rather than new devices: End-tidal CO₂ as a CPR quality target Ventilation strategies during arrest, including chest-compression-synchronised ventilation Cerebral oximetry as a potential prognostic signal These are not definitive answers, but they point towards cardiac arrest management that is more physiological and less ritualistic. Emergency department systems: repair, not reinvention A reflective discussion on “designer repair” challenges the idea that emergency departments need constant transformation.Instead, the focus shifts to recognising and supporting the clinicians quietly holding fragile systems together every day—and why fixing small, broken things often matters more than grand redesigns. Sepsis and antibiotics The episode closes with a critical look at broad-spectrum antibiotic use in suspected sepsis.Observational data suggest significant overtreatment and real harm, reinforcing the need to pause, think, and choose the right antibiotic—not just the fastest one. This episode is a reminder that good emergency medicine is rarely about silver bullets.It’s about judgement, physiology, and paying attention to what actually works in the real world. About MedPod Learn MedPod Learn is a medical podcast player designed to help turn listening into structured learning, with tools to support reflection, CPD, and appraisal.Available on the App Store and Google Play.

Some of the hardest moments in emergency medicine aren’t hard because they’re complicated.They’re hard because they’re rare — and when they arrive, you’re relying on things you last thought about a long time ago. This final episode in the Best Bits of 2025 series is the “file it away” collection: rare, high-stakes situations where preparation is largely cognitive, decisions are time-critical, and there may be no second chance. The clips in this episode are drawn from full St Emlyn’s episodes released during 2025 and focus on recognition, decision-making, and human factors in uncommon but consequential scenarios. In this episode, we explore How community response and live video have changed what happens before patients reach hospital Recognising and acting on decompression illness, even when presentations are subtle Cognitive HALOs — what happens to our thinking in rare, high-acuity situations Junctional haemorrhage and the role of the abdominal aortic junctional tourniquet Human decision-making under extreme pressure, illustrated through aviation medicine This episode is designed to be listened to slowly, and returned to when needed — the kind of learning that pays off long after you first hear it. Featured episodes Clips in this episode are taken from the following full St Emlyn’s episodes: Episode 262 — GoodSAM Update with Mark Wilson (London Trauma Conference) Episode 263 — Hyperbaric Medicine with Jeff Kerrie (London Trauma Conference) Episode 277 — Cognitive HALOs and Advanced Simulation Training with Halden Hutchinson-Bazely (BASICs) Episode 273 — Abdominal Aortic Junctional Tourniquet with Ed Barnard Episode 276 — Ejection Seats and the Injured Pilot with Phil Lucas (BASICs) 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 tools to support reflection, CPD, and appraisal.Available on the App Store and Google Play.

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.

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.

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.

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.

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

In the March 2025 episode of the St. Emlyn's podcast, Iain Beardsell and Simon Carley discuss a variety of topics covered in their latest blog posts and podcasts. Key discussions include the implications of cannabis edibles in emergency departments, expert viewpoints on pre-hospital resuscitative thoracotomy for traumatic cardiac arrest, and the use of ketamine for opioid-dependent patients. Highlights from recent conferences such as The Big Sick, IncrEMentuM 2025, and the Royal College of Emergency Medicine (RCEM) conference in Birmingham are shared. The episode also delves into department culture, addressing resilience, risk management, and other critical topics in emergency medicine. The podcast concludes with a recommendation of Matt Morgan’s book "A Second Act: What Nearly Dying Teaches About Really Living." 00:00 Introduction and March 2025 Roundup 01:45 Cannabis Edibles in the Emergency Department 05:25 Pre-Hospital Resuscitative Thoracotomy 12:38 Ketamine for Opioid Users in Acute Pain 15:17 Conference Highlights and Reflections 27:13 Matt Morgan's Inspirational Talk 30:50 Conclusion and Farewell

In this special edition of the St Emlyn’s podcast, Iain Beardsell and Simon Carley review the top medical papers of 2024, originating from Simon’s talk at The Big Sick conference in Zermatt. The discussion includes a comparison of non-invasive versus arterial pressure monitoring, the association of intra-arrest arterial blood pressure with ROSC, the efficacy of serratus anterior plane blocks for rib fracture management, and the evaluation of a micro axial flow pump in cardiogenic shock. They also delve into double sequential external defibrillation in refractory out-of-hospital cardiac arrest and provide a rapid-fire review of additional critical papers discussed at the conference. Notable mentions include the HEMOTION trial, PRE OXI trial, BLING III, and PARAMEDIC-3, among others. A must-listen for those passionate about evidence-based medicine in emergency and pre-hospital care. You can read more about all the trials, including links to all the papers here (part 1) and here (part 2) 00:00 Introduction and Conference Highlights 01:51 Non-Invasive vs. Arterial Pressure Monitoring 03:28 Intra-Arrest Blood Pressure and ROSC 05:34 Serratus Anterior Plane Blocks for Rib Fractures 08:38 Micro Axial Flow Pump in Cardiogenic Shock 10:49 Double Sequential Defibrillation in Cardiac Arrest 13:17 HEMOTION Trial 15:01 PRE OXI and BLING III Trials 17:08 Fluid Management in Septic Shock 18:37 Expedited Transfer vs. On-Scene Resuscitation 20:39 Intraosseous vs. Intravenous Access 21:48 Conclusion and Final Thoughts