St Emlyn’s is the premier emergency medicine podcast from the UK. We discuss evidence based medicine, clinical excellence, wellbeing and the philosophy of emergency care.
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In this month’s St Emlyn’s podcast, Iain Beardsell and Simon Carley work through some of the most interesting recent posts and papers from the blog. The conversation ranges from the latest pulmonary embolism guidance to the persistent problem of emergency department crowding, and from pre-hospital whole blood to the uneven availability of enhanced critical care across the UK. They also look at whether TOE might help us deliver more effective CPR, why arterial pressure may be a more useful resuscitation target than simply watching compressions, and a remarkable report from Gaza that challenges
What does it really mean to become an expert in resuscitation and critical care? It is tempting to think that expertise comes from accumulating enough facts, passing enough exams or simply spending 10,000 hours at work. In this episode, Iain Beardsell is joined by emergency physician, intensivist and medical educator Sara Crager to explore why expertise is less about how much we know and more about how we think. Sara explains how experts develop high-quality mental models that allow them to organise information, recognise patterns and approach difficult clinical problems. Crucially, these ment
In this episode of the St Emlyn’s Podcast, Iain Beardsell and Simon Carley catch up on the February blog posts, recorded in the rather unseasonal context of a UK heatwave. They begin with congratulations to Simon on his reappointment as Dean of the Royal College of Emergency Medicine, before reflecting on recent conferences including IFEM in Hamburg and Don’t Forget The Bubbles in Glasgow. The clinical focus this month is trauma team leadership, with practical tips on interpreting trauma CT reports, maintaining momentum after the scan, performing safer log rolls, and making feedback more usefu
In this episode of the St Emlyn’s Podcast, Iain Beardsell speaks with Anna Dobbie, consultant in emergency medicine and pre-hospital care, and Clinical Lead for London HEMS. Recorded at Trauma 2030 at the Royal College of Surgeons in London, the conversation explores what it means to lead exceptional teams in one of the most high-pressure areas of emergency medicine. Anna reflects on six years as Clinical Lead for London HEMS, sharing lessons on leadership, culture, psychological safety, difficult conversations, managing strong personalities, and supporting clinicians to do their best work. Th
In this episode, Iain and Simon catch up on the papers, posts, and conversations that have been sitting with us since the start of the year. Some are familiar. Some are uncomfortable. All of them feel relevant on shift. We start with the RSI trial — ketamine versus etomidate. A study that generated a lot of noise, and perhaps more certainty than it deserved. We move through trauma team leadership. Not as a checklist, but as a set of decisions made under pressure — when to call a Code Red, how to structure a handover, and what it means to lead a team that hasn’t worked together before. There’s
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•
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 de
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, bottle
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 discu
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 statutor
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 su
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.Desp
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
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 conse
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
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
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 wh
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
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
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 decisi
In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Simon Carley review blog posts from August and September. They reflect on their experience at the BASICs Conference, highlighting discussions on resuscitation science and new resuscitation council guidelines. Topics covered include the physiological-targeted resuscitation, arterial line placements during cardiac arrest, the PECan abdominal trauma rule in pediatric emergency care, intra-arrest stellate ganglion blocks, hydrofluoric acid burns treatment, and pediatric status epilepticus. They also delve into the evidence trial o
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
Surg Captain Ed Barnard joins St Emlyn’s at the BASICS Pre-Hospital Care Conference to discuss the abdominal aortic and junctional tourniquet — a last-resort device for catastrophic non-compressible haemorrhage. We explore how it works, what the evidence shows, and where it might fit in the future of trauma care.
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
Iain and Simon return after a brief hiatus to discuss key blog posts from April and May on the St Emlyn's Podcast. They highlight notable conferences including IncrEMentum 2025 in Spain, The Big Sick in Zermatt, and the BASICs Conference. Discussions cover content from recent emergency medicine research, the importance of compassion and patient-centred care, and operational strategies to avoid emergency department overcrowding. Insights are also shared from fieldwork in South Africa on emergency thoracotomies and their impressive survival rates.
