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.

 

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.

This bonus episode is a quick-fire collection of clinical pearls drawn from across the St Emlyn’s podcast in 2025.

Short, practical, and deliberately focused, these are the moments that make you stop and think:
“That’s useful — I want that in my head.”

There’s minimal commentary and no deep dives. Each clip stands on its own as a clear takeaway, designed to be listened to in one go or dipped back into when needed.

In this episode

• Practical triage language that lowers thresholds and prompts earlier action

• Time-critical decision-making in pre-hospital thoracotomy

• Resuscitation physiology and why diastolic pressure matters

• Intraosseous access and the reality of long-term complications

• Analgesia strategies for rib fractures, including posterior injuries

• Hydrofluoric acid burns and why improvised treatment is a trap

• Recognising and acting on decompression illness

• Cognitive HALOs and preparing for rare, high-load decision moments

• Building excellence in teams, not just avoiding failure

• Compassionate resuscitation and the value of the pause

This episode is designed to be saved, revisited, and shared — the kind of learning that pays off later.

Featured episodes

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

• Episode 257 — Ten Second Triage with Sean Brayford-Harris

• Episode 270 — Insights on Cannabis Edibles, Pre-Hospital Thoracotomy and more

• Episode 266 — Monthly Round Up (February 2025): Skills Fade and Resuscitation Targets

• Episode 260 — Monthly Round Up (December 2024): IO Access and Chest Trauma

• Episode 268 — Top Papers of 2024 from The Big Sick Conference

• Episode 275 — Targeted Resuscitation and Hydrofluoric Acid Burns

• Episode 263 — Hyperbaric Medicine with Jeff Kerrie

• Episode 277 — Cognitive HALOs and Advanced Simulation Training

• Episode 264 — High Performance Teams with Dan Dworkis

• Episode 258 — Compassionate Resuscitation with Matt Hooper

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.

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.

January often brings pressure to improve — to fix gaps, sharpen skills, and somehow be better than the year before. Done badly, that drive can become another source of burnout.

This third episode in the Best Bits of 2025 series focuses on how improvement actually works in emergency and acute care — and how to do it in a way that is realistic, sustainable, and kind to the people doing the work.

The clips in this episode are drawn from full St Emlyn’s episodes released during 2025 and reflect some of the most practical conversations about learning, feedback, and professional development from the year.

In this episode, we explore

• Why clinical skills fade faster than most of us realise — and why teaching is not the same as training

• How debriefing and video review can drive learning safely, when the culture is right

• The impact of artificial intelligence and algorithm-driven information on how clinicians learn and make decisions

• Why conferences, community, and being “in the room” still matter in medical education

This episode is designed for listening on the way to work, on the way home, or during a quieter moment when you’re thinking about how to improve practice without adding more weight.

Featured episodes

Clips in this episode are taken from the following full episodes:

• Episode 259 — Skills Fade with Nathalie Pattyn (Tactical Trauma 24)

• Episode 265 — Excellence in Debriefing with Richard Lyon (London Trauma Conference)

• Episode 267 — Social Media and Artificial Intelligence in Medicine with Peter Brindley

• Episode 274 — What Medical Conferences Offer in 2025 and How They’ve Changed

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 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.

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

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

Each clip comes from a full episode released in 2025.

In this episode, we explore:

• How ten-second triage is designed to work on “worst-day” scenarios, not in textbooks

• The uncomfortable truth about why procedures sometimes get done — and why that matters

• Why time, not technique, is often the limiting factor in resuscitative thoracotomy

• The case for earlier invasive monitoring in the sickest patients

• Where thinking around double sequential defibrillation may be heading

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

Featured episodes

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

• Episode 257 — Ten Second Triage with Sean Brayford-Harris (Tactical Trauma 24)

• Episode 269 — Monthly Round Up (January 2025): Decision-making and prehospital RSI

• Episode 270 — Insights on Cannabis Edibles, Pre-Hospital Thoracotomy and more

• Episode 266 — Monthly Round Up (February 2025): Targeted resuscitation and arterial lines

• Episode 268 — Top Papers of 2024 from The Big Sick Conference

All full episodes are available in the podcast feed.

About MedPod Learn

MedPod Learn is a clinician-built medical podcast player designed to turn listening into structured learning, with optional MCQs, reflection prompts, and saved activity for appraisal and CPD.
You can find it on the App Store and Google Play.

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

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

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

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

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

The Institute of Pre-Hospital Care

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

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

Listen on MedPod Learn

MedPod Learn is a new app that turns medical podcasts into structured learning.
Alongside the audio, you get concise learning points, exam-style MCQs, and short reflection prompts — with listening time and activity logged automatically for CPD and appraisal.
If you already learn through podcasts, this is a way to make that learning count.

Available now on iOS and Android.

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

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

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

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

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

Phil explains:
• Why the aviation environment is so hostile to humans and how aerospace medicine supports aircrew
• How modern ejection seats work – from canopy jettison and rocket firing to parachute deployment and landing
• The decision making required to eject in a matter of seconds, and how pilots are trained to be “mentally ready”
• Typical injury patterns after ejection, how technology has reduced spinal compression injuries, and where the remaining risks lie
• Practical considerations for ED and pre-hospital teams when a pilot presents after ejection, including spinal precautions and safe removal of flight equipment
• The psychological impact of surviving a crash or ejection, how support needs can change over months, and what helps people return to flying
• Aviation medicine as a career path, including the role of the RAF Centre of Aerospace Medicine, the diploma in aviation medicine, and how this can sit alongside general practice or emergency care

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