Pre-Hospital Care Podcast

In this episode of the Pre-hospital Care Podcast, we delve into the origins and current structure of the Hazardous Area Response Team (HART), a specialist unit within UK pre-hospital care. We explore why the HART model was specifically chosen in the UK and how it compares to Urban Search and Rescue (USAR) counterparts internationally. The conversation offers insights into the unique day-to-day role of a HART team member and how the team integrates with the wider emergency medical services, particularly during high-risk or complex incidents.We also reflect on the evolution of HART, how the model has grown from its early foundations into a sophisticated and responsive service that plays a crucial role in emergency preparedness and response. The episode explores the learning mechanisms and governance structures built into HART to ensure continuous development and safe practice.Additionally, we examine how change management and cultural integration have been essential to embedding HART within the wider healthcare and emergency response ecosystem. This includes addressing the 'hearts and minds' aspect, how to build trust, acceptance, and collaboration between specialist teams and frontline responders to ensure effective teamwork and optimal patient care.Whether you're familiar with HART or new to the concept, this episode offers a deep dive into one of the UK's most technically demanding emergency response capabilities and how it continues to shape the landscape of pre-hospital care.This episode is sponsored by PAX: The gold standard in emergency response bags.When you’re working under pressure, your kit needs to be dependable, tough, and intuitive. That’s exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They’ve partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn’t chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life. PAX – built to perform, made to last.Learn more at pax-bags.com

In Part 3 of The Dying Patient: Palliative and End of Life Care, we delve into the complexities ambulance clinicians face when supporting patients in their final days and hours. Often the first to recognise when someone is dying, paramedics work within a system where community engagement may be limited, making their role crucial in identifying signs such as terminal agitation, unconsciousness, and other common symptoms. The episode discusses the importance of anticipatory medications and proactive advance care planning , especially in situations involving carer breakdown or when patients change their minds about where they wish to die.We explore why ambulance services are frequently called during end-of-life stages, whether due to uncontrolled symptoms, sudden deterioration, or emotional distress within families. Paramedics not only offer symptom relief, both pharmacological and non-pharmacological, but also provide vital emotional support to those navigating grief, denial, or fear. Challenges include differentiating between reversible conditions and active dying, managing care when anticipatory medications are unavailable, and coordinating with wider healthcare teams.Breaking bad news is another critical area discussed, with a focus on using frameworks such as Ask-Tell-Ask and adapting communication to the emotional needs of the moment. Lastly, the episode reflects on cultural considerations in a city as diverse as London. From language barriers and different expressions of grief to religious rituals and care after death, ambulance clinicians must remain adaptable and compassionate, ensuring that care is respectful, inclusive, and sensitive to the needs of every individual and their family. Some of the links to information mentioned in the episode can be found here: These are some of the resources mentioned in the episode:Breaking Bad News: ⁠⁠https://www.sth.nhs.uk/clientfiles/File/Breaking%20bad%20news%20Reflection%20on%20the%20process.pdf⁠⁠Good Grief - understanding the grief journey in more detail: ⁠⁠https://good-grief.org/resources/⁠⁠Hospice UK, an excellent place for further resources: ⁠⁠https://www.hospiceuk.org/our-campaigns/dying-matters/dying-matters-awareness-weekUK National Guidelines on Diabetes and End of Life Care: https://www.diabetes.org.uk/sites/default/files/2025-03/EoL_TREND_2024_v11-1.pdfThis episode is sponsored by PAX: The gold standard in emergency response bags.When you’re working under pressure, your kit needs to be dependable, tough, and intuitive. That’s exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They’ve partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn’t chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at pax-bags.com

In Part 3 of our Decision Making series, we explore the power of "slow time" thinking with Detective Superintendent Ahenkora Bediako of the Metropolitan Police. With a distinguished career managing high-risk public protection departments and international investigations, Ahenkora brings deep insight into how intentional, non-biased decisions are made under pressure.We unpack how leaders can resist reactive impulses in crisis moments and instead lean into deliberate, evidence-informed strategies, especially when the stakes are high. Drawing on his experience as an Accredited Major Crime Senior Investigating Officer (PIP3), Ahenkora shares lessons from frontline policing, complex safeguarding, and professional standards.We also touch on his commitment to evidence-based policing, including randomised control trials, and how these approaches improve outcomes in child protection, community engagement, and organisational equity. If you're interested in high-performance leadership, decision integrity, and building inclusive, accountable systems, this episode is for you. This episode is sponsored by PAX: The gold standard in emergency response bags.When you’re working under pressure, your kit needs to be dependable, tough, and intuitive. That’s exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They’ve partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn’t chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at pax-bags.com

Today, we’re diving into a critical yet often overlooked subject: rehabilitation for pre-hospital staff. The physical and mental demands of frontline work are relentless. Paramedics, HEMS crews, and pre-hospital teams operate in high-stress environments, managing unpredictable situations, heavy workloads, and repeated exposure to trauma. But what happens when the body or mind says, “I can’t keep going”? How do we help our colleagues recover and return, not just functioning, but stronger, healthier, and more resilient?I’m joined by Mike Palmer, a highly experienced critical care clinician with lived experience of injury and recovery. Together, we’ll unpack the scale of injury across pre-hospital care, identify gaps in current rehabilitation practices, and explore why a structured, personalised approach is essential for long-term sustainability in this field. We’ll also take a personal look at Mike’s own journey, how he navigated his recovery, the obstacles he encountered, and the insights he gained along the way.But this conversation goes beyond rehabilitation, it’s about reimagining how we care for those who care for others. Whether you're on the frontline, leading a team, or simply passionate about well-being in emergency medicine, this episode offers valuable perspectives on how we can better support, rehabilitate, and retain our pre-hospital workforce. Useful links that Mike mentions in the episode can be found here:https://pubmed.ncbi.nlm.nih.gov/31537564/https://www.sciencedirect.com/science/article/pii/S0925753524000092https://pubmed.ncbi.nlm.nih.gov/33492279/https://pubmed.ncbi.nlm.nih.gov/35000895/https://pubmed.ncbi.nlm.nih.gov/26371071/https://pubmed.ncbi.nlm.nih.gov/34972683/https://pubmed.ncbi.nlm.nih.gov/26371071/https://pubmed.ncbi.nlm.nih.gov/26281820/This episode is sponsored by PAX: The gold standard in emergency response bags.When you’re working under pressure, your kit needs to be dependable, tough, and intuitive. That’s exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They’ve partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup. PAX doesn’t chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at pax-bags.com

Today, we explore the collective experience of trauma among NHS ambulance personnel during the COVID-19 pandemic, a period that tested the resilience and identity of clinicians like never before. In the episode, we’ll uncover the inspirations behind this research, examining how social identity processes provide a profound lens to understand how ambulance teams navigate trauma. Our guest will walk us through their methodology, highlighting the value of a longitudinal qualitative approach and the unique hurdles of conducting research during a global crisis.Jo guides us through her methodology, highlighting the importance of longitudinal qualitative approaches and the challenges of conducting research amid a global crisis. We unpack how group membership shaped emotional and behavioural responses during the pandemic, revealing the cultural forces at play within NHS ambulance services and how these dynamics contributed to collective resilience.We also explore the long-term psychological impact of the pandemic, comparing individual and team-based coping strategies, and discuss what this tells us about building solidarity under extreme strain.Finally, Jo shares practical, evidence-based strategies for leaders in emergency services to foster resilience, mitigate trauma, and apply these learnings to other high-stakes professions.Dr. Jo Mildenhall is a paramedic with over 20 years of experience in operational and leadership roles within ambulance services. She holds a master’s degree in Occupational Trauma Psychology from the University of Nottingham and earned her Doctorate from the University of York, focusing on trauma experienced by NHS ambulance staff during the pandemic. Jo is the National Paramedic Mental Health & Wellbeing Lead for the College of Paramedics and was awarded a Churchill Fellowship in 2019 to study paramedic mental health initiatives in Australasia. You can access Jo's research here: https://etheses.whiterose.ac.uk/id/eprint/35774/

In our previous episode, we explored the meaning and importance of end-of-life care, particularly during the final 12 months of life. We discovered how difficult it is to predict this timeline, especially for ambulance clinicians who often see patients at critical points without a full picture of their medical history.In this episode, we take a closer look at what that final year can involve, focusing on the pre-hospital setting. We’ll explore the unique challenges ambulance clinicians face in making rapid, high-stakes decisions, and how existing documentation—such as care plans or advance directives—can provide valuable guidance in those moments.We'll also discuss the role of shared decision-making and how ambulance services can help balance specialist and generalist palliative care needs. Alongside this, we’ll highlight how the NHS Long Term Plan and other key initiatives aim to improve care coordination and ensure more consistent, compassionate care.Lastly, we’ll examine the barriers to effective advance care planning. These range from cultural sensitivities to systemic and logistical obstacles. Throughout, we’ll consider how we can better support ambulance clinicians to deliver thoughtful, person-centred care during some of life’s most vulnerable and uncertain moments. Please find links to the SPICT Tool that is mentioned in the episode: https://www.spict.org.uk/#:~:text=Supportive%20%26%20Palliative%20Care%20Indicators%20Tool,is%20a%20plain%20language%20version.

In this episode, we dive into a critical challenge: how to embed meaningful, lasting change within ambulance services. With increasing demand, stretched resources, and ongoing operational pressures, creating improvements that truly stick is no easy task.To unpack this, I’m joined by Carl Betts, an expert in quality improvement, leadership, and change management within the ambulance sector. Carl has been instrumental in transforming clinical practices, enhancing patient care, and fostering a culture of continuous improvement at Yorkshire Ambulance Service and beyond. Aspects we cover in the episode include:🔹 The challenges of implementing change in high-pressure environments🔹 Engaging frontline staff to drive meaningful improvements.🔹 Moving beyond short-term fixes to create sustainable change.🔹 Overcoming resistance to change and managing change fatigue.🔹 The role of innovation and technology in shaping the future of pre-hospital care.

In this engaging discussion, Stephen Wood—an emergency nurse practitioner and tactical medicine educator—shares his extensive knowledge of high-threat care. He dives into the use of innovative blood products in trauma and the complexities of pleural drainage techniques. The conversation highlights the critical role of mental health in high-stress medical environments and emphasizes the need for team cohesion and resilience. Wood also discusses advancements in medical technology and the importance of thorough training for tactical medics facing real-world emergencies.

In today’s episode, we’re honoured to be joined by John Martin, a trailblazer whose career is a testament to innovation, leadership, and an unwavering dedication to patient care.John’s journey began at just 18 in a microbiology lab, but his passion for healthcare quickly led him to the world of emergency medicine. Today, he serves as the Chief Executive of South Western Ambulance Service NHS Foundation Trust (SWASFT). With a wealth of experience across ambulance, acute, and community healthcare settings, John has also been the President of the College of Paramedics, advocating for the advancement of the paramedic profession. As a Visiting Professor in Paramedic Science, he’s helping shape the future of paramedic education and training.In this episode, we’ll dive into John’s leadership transition from London Ambulance Service to SWASFT, the biggest challenges facing pre-hospital care, and the role of technology in modernising emergency response. We’ll also touch on the importance of mental health, interdisciplinary collaboration, and John’s forward-thinking vision for the future of paramedic practice. A link that John mentions in the interview to the Harvard Business School Negotiation Mastery course can be found here: https://tinyurl.com/2f8pdbkcThis podcast is sponsored by PAX.⁠Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range, please click here:⁠https://www.pax-bags.com/en/⁠

In this episode, I’m joined by Marc Watson, a distinguished pharmaceutical physician and passionate advocate for mental health. Marc’s journey spans from working as a frontline GP to holding senior leadership roles in pharmacovigilance and global medical affairs, where he has been instrumental in ensuring patient safety, meeting regulatory demands, and supporting the launch of transformative medicines. Yet, behind these professional achievements lies a deeply personal story: Marc’s own experience of managing a bipolar diagnosis while navigating high-pressure, high-stakes environments.We’ll explore his shift from clinical practice to the pharmaceutical sector, the emotional toll of leadership, and the practical tools he uses to safeguard his mental well-being. Marc also opens up about his drive to raise mental health awareness, offering honest reflections from his life.This episode is a candid conversation about leadership, resilience, and the power of vulnerability. It highlights the urgent need to normalise mental health discussions, especially in professions where the pressure is relentless. Whether in healthcare, leading teams, or seeking perspective on mental wellness, this episode offers meaningful insight. You can read more on Marc's mental health journey here: https://www.fpm.org.uk/blog/from-surviving-to-thriving-with-my-mental-health/This podcast is sponsored by PAX.Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid access to deliver the right gear at the right time to the right patient. To see more of their innovative designed product range, please click here:⁠https://www.pax-bags.com/en/⁠