The St.Emlyn’s Podcast Ep 279 - Best Bits of 2025: Decisions When It’s Busy
Dec 20, 2025
Sean Brayford-Harris, a pre-hospital and tactical trauma clinician, shares his expertise on decision-making during high-pressure situations. He discusses the innovative Ten Second Triage tool, emphasizing the importance of prioritizing walking patients and recognizing severe bleeding. Sean advocates for a more responsive approach in triage and explores the critical timing of thoracotomies and defibrillation techniques. His insights aim to enhance emergency medical practices, particularly when time is of the essence.
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Rapid Ten‑Second Triage For Ugly Days
- Use the Ten-Second Triage flow to sort casualties rapidly on worst-day scenes with simple checks like walking, severe bleeding, talking and breathing.
- Empower and use bystanders as force multipliers and lower thresholds for 'severe' bleeding to prompt early intervention.
Choose Skilled Teams Over Delayed Novel Crews
- Prefer small, practiced teams for high-stakes procedures because familiarity speeds execution and may beat waiting for a new team in ED.
- Reflect on whether performing a procedure is truly required or driven by clinician opportunity; only the patient's need is valid.
Pre‑Hospital Thoracotomy Survivor Story
- Sean Brayford-Harris described a pre-hospital thoracotomy survivor who arrested in front of the team and survived after immediate intervention.
- The survivor walked out of hospital with good neurological outcome, illustrating time-critical resuscitation success.