The St.Emlyn’s Podcast

Sheldon Cheskes, resuscitation scientist and emergency medicine professor known for DOSE VF and drone AED work. He explains refractory versus recurrent VF, how double sequential external defibrillation and vector change alter current pathways, and why timing and system protocols matter. The conversation covers trial evidence, practical steps for safe DSED rollout, and future tech like detection sensors and drone AED delivery.

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

You’re about to hear a conversation about doing less. But it isn’t really about doing less. It’s about time. Recorded at Trauma 2030 at the Royal College of Surgeons, this episode explores a shift in mindset in pre-hospital trauma care — away from maximal intervention on scene and towards rapid recognition of the patient who cannot be fixed pre-hospital. I’m joined by Harriet Tucker — consultant at London’s Air Ambulance, HEMS Governance Lead at Air Ambulance Kent Surrey Sussex, and Trauma Team Leader at St George’s Major Trauma Centre — to talk about damage control pre-hospital care. We discuss: Using time as a treatment Recognising non-compressible haemorrhage Why one line may be enough Moving interventions into the ambulance Changing the pre-alert The “pit stop” resus Taking patients straight to theatre Cultural resistance to doing less Governance, debrief, and looking after teams This approach focuses on a small but critically unwell group of patients — often penetrating trauma with rapidly exsanguinating haemorrhage — where the only definitive treatment is surgical control of bleeding. The key intervention is speed. Harriet also discusses the governance work behind this change, the importance of reviewing every case, and how to bring ambulance services and in-hospital teams along with the shift in thinking. This episode is part of a series recorded at Trauma 2030. More conversations from the meeting will follow in upcoming episodes.  Upcoming events Harriet will be speaking at Tactical Trauma, 2–4 November, Sundsvall, Sweden. IncrEMentuM is now only eight weeks away, with limited tickets remaining. Learning from podcasts? If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. Trauma 2030 TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.  

In this episode of the St Emlyn’s Podcast, we’re joined by Nigel Ruddell, Medical Director of the Northern Ireland Ambulance Service, recorded live at the BASICS Conference. This is a conversation about Helicopter Emergency Medical Services (HEMS) — but not in the way you might expect. It’s not really about aircraft. It’s about people. Nigel talks us through the long, often uncomfortable journey to building Air Ambulance Northern Ireland. From early fundraising attempts in the 2000s, through the influence and legacy of Dr John Hinds, to the eventual partnership between charity and the statutory ambulance service that made a doctor–paramedic HEMS model possible. We explore: • Why the helicopter isn’t the intervention — the team is • 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 episode of the St Emlyn’s Podcast, Iain Beardsell and Simon Carley talk with Caroline Leech at the BASICs Conference about resuscitative hysterotomy following maternal cardiac arrest. This is a calm, evidence-led discussion of a rare, high-stakes intervention that most clinicians will encounter once, if at all — and still need to get right. What we cover Why the term resuscitative hysterotomy has replaced perimortem caesarean section The physiological rationale: relieving aortocaval compression to improve maternal resuscitation What the evidence actually shows about timing, maternal survival, and neonatal outcomes Findings from Caroline’s systematic review of out-of-hospital cardiac arrest in pregnancy Why the “4–5 minute rule” does not reflect real-world pre-hospital care Neonatal survival at far longer timelines than traditionally taught Practical decision-making in pre-hospital and emergency department settings Who should perform the procedure, and why speed matters more than seniority Aftercare challenges: open abdomen, placenta management, bleeding (or lack of it) Team cognitive load, role allocation, and when termination at scene is appropriate The emotional and professional impact on clinicians and families Key takeaways Maternal survival after out-of-hospital arrest is rare, but not zero Neonatal survival is higher than often appreciated, even with prolonged timelines Delaying purely to reach hospital or a specialist may reduce benefit The hardest part is not the incision — it is the decision, coordination, and aftermath Training should focus as much on judgement and communication as on technical skill This episode is not about heroics. It is about realism, evidence, and being prepared for one of the most confronting moments in emergency care. 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. IncrEMentum 2026 - April 22 - 24 IncrEMentuM was born to revolutionise how we approach emergency medicine. It’s not a traditional conference — it’s an immersive experience that pushes professionals to act, think, and make decisions in real time. Our mission is to bring together healthcare providers, experts, and emergency personnel from around the world to share experiences, train in realistic scenarios, and test their skills under extreme pressure. In 2026, we return with an even more intense and lifelike edition — all with one clear goal: to prepare you for what cannot be predicted. Tactical Trauma - April 22 - 24 This is an international conference covering various aspects of working in high-stakes environments, primarily related to pre-hospital trauma and critical care, with a tactical twist. Our program is rich and diverse, featuring state-of-the-art lectures from world-class speakers. We aim to bring together all organisations working with pre-hospital trauma in tactical/hostile environments, including physicians, HEMS, EMS, police anti-terror units, military, fire and rescue services and more.  

Explore the latest findings in trauma care, including a trial that challenges the use of fresh frozen plasma in severe hemorrhage. Discover advances in upper limb analgesia with nerve blocks tailored for procedural needs. The discussion highlights key physiological signals during cardiac arrest, emphasizing end-tidal CO₂ as a crucial CPR quality marker. Delve into the importance of careful antibiotic use in sepsis and strategies to improve survival rates in cardiac arrests. The hosts advocate for practical solutions to enhance emergency department systems.

A rapid collection of clinical pearls covering practical triage wording to prompt earlier action. Time-critical decisions in pre-hospital thoracotomy and resuscitation targets focused on diastolic pressure. Real-world IO safety data and analgesia options for rib fractures. Warnings on hydrofluoric acid care, recognising decompression illness, cognitive prep for high-load moments, and building excellence with compassionate pauses.

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.

The discussion highlights the surprising speed at which clinical skills can fade, emphasizing the need for regular training over mere teaching. It dives into the power of video debriefing for effective feedback in a supportive culture. There's a focus on how artificial intelligence impacts clinicians' learning and decision-making, stressing the importance of critical thinking. Community engagement and in-person conferences are celebrated for their role in enhancing medical education and fostering connections among professionals.

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.