The St.Emlyn’s Podcast

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.  

Explore the latest findings in trauma care, including a trial that challenges the use of fresh frozen plasma in severe hemorrhage. Discover advances in upper limb analgesia with nerve blocks tailored for procedural needs. The discussion highlights key physiological signals during cardiac arrest, emphasizing end-tidal CO₂ as a crucial CPR quality marker. Delve into the importance of careful antibiotic use in sepsis and strategies to improve survival rates in cardiac arrests. The hosts advocate for practical solutions to enhance emergency department systems.

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.

The discussion highlights the surprising speed at which clinical skills can fade, emphasizing the need for regular training over mere teaching. It dives into the power of video debriefing for effective feedback in a supportive culture. There's a focus on how artificial intelligence impacts clinicians' learning and decision-making, stressing the importance of critical thinking. Community engagement and in-person conferences are celebrated for their role in enhancing medical education and fostering connections among professionals.

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.

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.

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.

Haldon "Hutch" Hutchinson-Bazely, an intensive care and pre-hospital medicine doctor, discusses his transformative experiences in emergency situations. He shares gripping insights from a harrowing traumatic cardiac arrest encounter, where he faced cognitive overload alone. Hutch presents techniques like 'lighting a flare' to manage stress and decision-making. The conversation dives into the importance of high-fidelity simulation training in preparing clinicians for high-stakes scenarios, and small-scale methods to make such training accessible globally.

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.