The St.Emlyn’s Podcast

Recorded at Trauma 2030 at the Royal College of Surgeons in London in December 2025, this short St Emlyn’s podcast looks at one of the most challenging situations in prehospital and emergency care: traumatic cardiac arrest.

Iain is joined by Laura Kocierz, a Consultant with London’s Air Ambulance and a Consultant in Critical Care Medicine and Anaesthesia in the Midlands.

In this conversation, Laura and Iain explore how data can help us make better decisions about resuscitative thoracotomy.

Traumatic cardiac arrest is not always a simple binary event. Patients may deteriorate through a prof...

When does a raised troponin become a myocardial infarction? What has happened to “type 2 MI”? And how certain can we be about the diagnosis without imaging?

Iain Beardsell introduces Professor Rick Body for a practical guide to the Fifth Universal Definition of Myocardial Infarction. Rick explains the changes in terminology, troponin interpretation and diagnostic criteria, focusing on what they mean for clinicians assessing patients in the emergency department.

Iain Beardsell and Simon Carley return for the April 2026 St Emlyn’s podcast update, talking through another busy month of posts from the St Emlyn’s team and guest authors.

This month brings trauma, systems thinking, public health and pulmonary embolism, with plenty of practical ideas to take back to your next shift.

Iain and Simon start with three more of Simon’s Trauma Team Leader Tips.

The first looks at external haemorrhage control. Tourniquets save lives, but they are not the answer to every bleeding wound. Simon describes a practical escalation from accura...

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 some...

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 mental models do not...

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 useful for...

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.

The discussion also touches on 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 m...

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...

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 ma...

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

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...

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 an...

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.

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

Fi...

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.

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 b...

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.

Practical triage language that lowers thresholds and prompts earlier action

Time-critical decision-making in pre-hospi...

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 uncommo...

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 pr...

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.

What a genuine learning culture looks like on shift — and why it matters more t...

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 procedur...

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...

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...

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<...

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 on moving patients with refractory out-of-hospital cardiac arrest to hospitals for specialised care, and review discussions on...

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...

Recorded at the BASICS Pre-Hospital Care Conference at Sketchley Grange, this episode explores one of the most experimental tools in civilian trauma care — the abdominal aortic and junctional tourniquet. Dr Ed Barnard joins us to discuss why this device was developed, how it works, and where it might — just might — save lives when all other options have failed.

The conversation traces the problem of non-compressible haemorrhage, the leading cause of potentially survivable trauma death. Conventional limb tourniquets, pelvic binders and packing can’t reach these deep bleeding sites. The AAJT offers a radical alternative: external aortic compression to buy a...

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...

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.

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...

In this episode of the St Emlyn's Podcast, Iain Beardsell and Simon Carley revisit January's  blog posts and podcasts, covering several seminal studies relevant to emergency and pre-hospital care.

Topics include the Sub 30 Feasibility Study on pre-hospital ECMO, comparisons of pre-hospital versus in-hospital emergency anaesthesia, variations in maintenance of pre-hospital anaesthesia in trauma patients, and the effectiveness of physician-led pre-hospital teams.

They also discuss the economic implications of advanced pre-hospital interventions and highlight reviews from the London Trauma Conference.

00:00 Introduction and January Recap

01:58 Pre-Hospital ECPR Study: The Sub 30 Study

07:09 E...

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 pape...

Join hosts Iain Beardsell and Natalie May at the London Trauma Conference as they welcome Peter Brindley back to the St Emlyn’s podcast. In this engaging episode, they delve into the nuances of social media, digital footprints, and the burgeoning influence of artificial intelligence in medicine. Brindley discusses the importance of maintaining an authentic digital presence and addresses the impact of misinformation and disinformation in the digital age. They explore the challenges and opportunities presented by AI in clinical decision-making and share insights on navigating this evolving landscape as healthcare professionals. Tune in for a thought-provoking conversation on st...

In this episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley reflect on their experiences at recent conferences, including the IncrEMentuM 2025 and The Big Sick. They discuss the exceptional quality and innovative formats of presentations at IncrEMentuM, emphasizing the enthusiasm and positive atmosphere. The discussion also covers key emergency medicine topics from February's blog posts, including the maintenance of clinical skills, the importance of diastolic blood pressure in resuscitation, and a systematic review on resuscitative hysterotomy. Additionally, they explore new guidance on the diagnosis of death, particularly in intensive care settings. Special thanks to Galen Pharmaceuticals and...

In this episode of the St Emlyn's Podcast, Iain Beardsell and Natalie May speak with Richard Lyon, an emergency doctor and deputy medical director of the air ambulance service at Kent, Surrey, and Sussex. Recorded at the London Trauma Conference 2024 in Kensington, Richard shares experiences and lessons from his talk on five critical cases that shaped him as a clinician and human being.   Discussion topics include the importance of case debriefing, the impact of video recording in clinical practice, overcoming the challenges of self-reflection, and the evolving culture of pre-hospital emergency medicine. Richard emphasizes the significance of supportive and structured d...

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe welcome Dan Dworkis, an ER doctor from Los Angeles and host of the Emergency Mind podcast. Dan shares his expertise on optimizing team and individual performance in high-stress medical environments. The discussion delves into the concept of excellence beyond merely avoiding negative outcomes, using a rosebush metaphor to illustrate the need for proactive growth. They explore how teams can benchmark and improve performance, the importance of creating a culture of continuous improvement, and strategies to maintain positivity and energy even in challenging conditions. Dan also highlights...

In this episode of the St. Emlyn's podcast, hosts Iain Beardsell and Natalie May discuss hyperbaric medicine at the London Trauma Conference with Dr. Jeff Kerrie, an internal medicine physician from Canada. Dr. Kerrie provides insights into dive and hyperbaric medicine, covering the basics of hyperbaric therapy, its applications, and key practices for emergency departments when treating patients with decompression illness. The conversation also touches on misconceptions and unregulated uses of hyperbaric chambers, emphasizing the importance of consulting certified medical professionals.

In this episode, Iain Beardsell and Natalie May speak with neurosurgeon Mark Wilson at the London Trauma Conference. Mark provides an in-depth look at the evolution of the GoodSAM app over the past decade. Initially designed to alert off-duty trained individuals to assist in emergencies, particularly for cardiac arrests and impact brain apnoea, the app has grown to include applications in police services, public health during COVID-19, and community volunteer efforts.   It employs advanced technology, such as real-time video guidance and AI, to offer immediate assistance and improve outcomes in medical emergencies and other crises.   Mark's insights shed light on ho...

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe welcome back Caroline Leech, a emergency medicine consultant with extensive pre-hospital care experience. Caroline discusses the concept of moral injury, delving into its distinction from moral distress. She introduces three mechanisms of moral injury: acts of commission, acts of omission, and betrayal. Caroline provides insightful examples from emergency medicine to illustrate these concepts, emphasizing the importance of identifying and addressing moral injury to support healthcare professionals. The discussion highlights the emotional and cognitive distress faced by emergency responders and the necessity for professional psychological support when...

In this season-ending episode of the St Emlyn's podcast, Iain Beardsell and Simon Carley come together in Zermatt, Switzerland, to discuss recent studies and updates.

They highlight a randomized control trial on early exercise in blunt chest wall trauma, revealing its limited impact on recovery outcomes. Additionally, they explore the long-term safety of intraosseous access based on new evidence from Denmark.

The episode also provides insights into updated imaging guidelines for paediatric trauma and broad considerations on the growing role of AI in healthcare, especially in emergency settings. There are closing remarks on recent blog...

In this episode of the St Emlyn's podcast, hosts Iain Beardsell and Liz Crowe talk with Nathalie Pattyn at TacTrauma24 in Sweden about the phenomenon of skills fade amongst emergency physicians.

Nathalie discusses her extensive background in medicine, psychology, and neuroscience, and shares insights from her research on how skills can deteriorate during low workload deployments, such as her 15-month clinical stint in Antarctica.

They delve into the lack of systemic measures to address returning to practice after long absences, how cognitive and psychomotor skills are affected by skill fade, and the contrast between teaching...