Pre-Hospital Care Podcast

In pre-hospital care, few diagnoses carry the same urgency as stroke. But not all strokes present the way we expect, and that’s where the risk lies. In this episode, we explore the challenge of recognising posterior circulation strokes, using both clinical insight and lived experience. I’m joined by Shane Devlin, a registered paramedic and newly appointed PhD researcher focusing on posterior stroke recognition. His work builds on frontline experience and a growing body of evidence that highlights just how easily these patients can be missed.
Alongside Shane, this conversation is grounded in a personal story: my brother, Ronan Walker, who suffered a posterior stroke 4 years ago in his late 30's. His presentation didn’t fit the traditional mould. There was no clear FAST-positive picture, just subtle, evolving symptoms that required a different kind of clinical suspicion.
This episode sits at the intersection of science and story. We unpack the limitations of current assessment tools, the cognitive challenges clinicians face in the field, and what needs to change to improve recognition. Because in a posterior stroke, the issue often isn’t treatment, it’s getting patients to treatment in time.
Shane has published both case studies and qualitative research on PCS. Both can be found here: Paramedic recognition of posterior circulation stroke: a vignette and focus group study
https://pubmed.ncbi.nlm.nih.gov/37674916/

Not so FAST: pre-hospital posterior circulation stroke:
https://pdfs.semanticscholar.org/06a1/f16d9062708b6f4ff8bb29efb7d9a61b43db.pdf

⁠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 ⁠https://www.pax-bags.com/en/⁠

Airway management remains one of the most critical and technically demanding aspects of pre-hospital care. In this special Pre-Hospital Airway Compilation, we bring together leading voices in airway management to explore the fundamentals, controversies, and high-stakes realities of managing the airway outside the hospital environment.
Across these conversations, we move from airway assessment and respiratory evaluation through to advanced interventions including rapid sequence induction, Suction Assisted Laryngoscopy and Airway Decontamination (SALAD), and Front of Neck Access (FONA). We examine the challenges unique to the pre-hospital environment, discuss practical approaches to decision-making under pressure, and explore where clinicians fit into a stepwise airway management strategy—from optimisation and monitoring all the way through to invasive surgical techniques.
Joining us first is John Chatterjee. John is a Consultant Anaesthetist with interests in pre-hospital care, difficult airway management, thoracic anaesthesia, and high-risk anaesthesia.
Alongside John, we are joined by Cliff Reid, a retrieval physician with more than two decades of experience across air ambulance and critical care transport services. This episode aims to provide practical insights into one of pre-hospital medicine’s most challenging and consequential interventions.

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 ⁠https://www.pax-bags.com/en/⁠

VitalStream from BHA Medical sponsors this podcast: Closing the Haemodynamic Blind Spots in Acute and Pre-Hospital Care
VitalStream is a wireless, wearable, non-invasive haemodynamic monitoring platform designed to deliver continuous, real-time physiological data, so you’re not relying purely on intermittent cuff readings when patients are unstable, moving, or in non-traditional care environments.
BHA Medical’s VitalStream solution focuses on integrating this level of monitoring into acute care workflows, streaming real-time data to a centralised platform, supporting earlier recognition of deterioration and more informed clinical decision-making.
In corridor medicine, where patients are often managed outside traditional monitored spaces, the challenge is missed deterioration between spot checks. Continuous trending helps reduce those “blind spots,” enabling earlier identification of haemodynamic decline and better prioritisation when systems are under pressure.
And in pre-hospital care, the value is in maintaining a clear physiological narrative from first patient contact through to hospital handover. VitalStream is designed for rapid deployment, applied, calibrated, and delivers data within around 90 seconds, using a low-pressure finger sensor that allows teams to follow trends in real time, rather than relying on isolated snapshots.
For more information, visit: https://www.bha-medical.com/vitalstream-patient-monitoring

In pre-hospital care, timing isn’t just important; it’s everything. The difference between a good outcome and a devastating one can come down to minutes and decisions, and few decisions are more critical than knowing when to bring advanced critical care to the scene.
In this episode, we’re joined by Critical Care Paramedic Callum Sutton from Great Western Air Ambulance Charity (GWAAC) to explore a question that sits at the heart of pre-hospital medicine: when does HEMS truly add value? This isn’t about calling early for the sake of it; it’s about understanding the patients, the physiology, and the interventions that can change trajectories.
But just as important is what happens before the helicopter lands. From optimising access and monitoring to anticipating procedures like pre-hospital emergency anaesthesia, small actions on the ground can translate into critical time saved. This is a conversation about foresight, teamwork, and marginal gains, and how, in the right moments, those gains can mean everything.

This episode is supported by the Great Western Air Ambulance Charity (GWAAC).
GWAAC’s Clinical Symposium takes place on Friday, 16 October 2026, at Ashton Gate Stadium, Bristol, with this year’s theme: Innovation. The event will focus on practical, implementable ideas shared by GWAAC’s Critical Care Team and guest speakers, designed for clinicians to take directly back into practice and apply quickly, rather than years down the line.
Limited availability: ~120 tickets only
Tickets on sale from June 2026
Early interest sign-up is available now
Also includes updates on other GWAAC clinical engagement events
Find out more and register interest: https://gwaac.com/symposium

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 ⁠https://www.pax-bags.com/en/⁠

This geriatric compilation explores the intersecting challenges of frailty, falls, and delirium in older adults, core issues in both pre-hospital and acute care. Frailty increases vulnerability to injury and poor outcomes, with falls often resulting in hospitalisation, loss of independence, and increased mortality. Alongside this, delirium remains common yet frequently under-recognised, often triggered by infection, dehydration, medications, or chronic disease, and presenting significant diagnostic and management challenges.
We examine structured approaches to assessment, including frailty scoring and cognitive evaluation, alongside the practical realities of decision-making in time-critical environments. A key focus is the differentiation between delirium, dementia, and other causes of confusion, and how sensory impairments can further complicate communication and assessment. The episode emphasises the importance of empathy, particularly when engaging with patients and families during periods of acute vulnerability.
Attention is given to the interface between pre-hospital and hospital teams, exploring barriers to effective communication, the importance of structured handovers, and the development of proactive, multidisciplinary care pathways to reduce recurrent harm. Ethical considerations, family dynamics, and prevention strategies are also discussed.
Featuring insights from Iain Wilkinson, James Adams, and Georgie Gill, this episode highlights integrated, system-wide approaches to improving outcomes for older patients.

You can listen to the individual episodes here: 
Frailty in Geriatric Patients with Iain Wilkinson and James Adams. Part 1, Geriatric Series: https://podcasts.apple.com/gb/podcast/frailty-in-geriatric-patients-with-iain-wilkinson/id1441215901?i=1000695425594

Delirium, Confused States, and Elderly Pathologies with Iain Wilkinson and James Adams. Part 2, Geriatric Series: https://podcasts.apple.com/kz/podcast/delirium-confused-states-and-elderly-pathologies-with/id1441215901?i=1000698533443

Improving communication and decision-making within Geriatric care. Part 3, with Iain Wilkinson and Georgie Gill: https://podcasts.apple.com/kz/podcast/improving-communication-and-decision-making-within/id1441215901?i=1000700542486

⁠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 ⁠https://www.pax-bags.com/en/⁠

In today’s conversation, we move beyond the idea of simply recording numbers in the cardiac arrest patient. Instead, we explore how physiological data can be used to guide real-time resuscitation, helping clinicians understand what is happening inside the patient, how interventions are working, and where care should go next. 
Joining us as the guest to discuss this is Mark Faulkner. Mark is an Advanced Paramedic for Hampshire and Isle of Wight Air Ambulance (HIOWAA), where he provides clinical leadership through his critical care practice. His work spans frontline practice, education, quality improvement, and the development of clinical pathways that shape the delivery of advanced pre-hospital care. This is the reading list associated with the episode:
Barreto, A. et al. (2020) ‘Diastolic blood pressure and survival in cardiac arrest’, Resuscitation, 155, pp. 1–8.
Bernard, S.A. et al. (2024) ‘Physiology-guided resuscitation in cardiac arrest’, Journal of Clinical Medicine, 13(12), p. 3527.
Brede, J.R. et al. (2019) ‘Prehospital REBOA in cardiac arrest’, Resuscitation, 140, pp. 136–143.
Butterfield, E. et al. (2024) ‘Prehospital arterial monitoring in cardiac arrest’, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1).
Kruit, N. et al. (2025) ‘Prehospital ECPR (PRECARE study)’, Resuscitation, 188.
Nolan, J.P. et al. (2021) ‘European Resuscitation Council Guidelines’, Resuscitation, 161, pp. 98–114.
Perkins, G.D. et al. (2018) ‘Epinephrine in OHCA’, New England Journal of Medicine, 379(8), pp. 711–721.
Rubertsson, S. et al. (2014) ‘LINC trial’, JAMA, 311(1), pp. 53–61.
Sutton, R.M. et al. (2014) ‘Hemodynamic-directed CPR’, Resuscitation, 85(3), pp. 397–402.
Yannopoulos, D. et al. (2020) ‘Advanced reperfusion strategies’, Circulation, 141(10), pp. 784–796.
Rees, P. et al. (2023) ‘Prehospital arterial blood pressure monitoring and outcomes in cardiac arrest’, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.
Barrett, J. et al. (2023) ‘Diastolic blood pressure and ROSC in OHCA’, Resuscitation.

VitalStream from BHA Medical sponsors this podcast: Closing the Haemodynamic Blind Spots in Acute and Pre-Hospital Care
VitalStream is a wireless, wearable, non-invasive haemodynamic monitoring platform designed to deliver continuous, real-time physiological data, so you’re not relying purely on intermittent cuff readings when patients are unstable, moving, or in non-traditional care environments.
Using AI-driven analytics and patented Pulse Decomposition Analysis, it provides continuous blood pressure alongside advanced haemodynamic parameters such as cardiac output, stroke volume, systemic vascular resistance, and fluid status. The aim is simple but critical: to help clinicians understand not just what the blood pressure is, but why, and whether a patient is fluid responsive or in need of a different intervention.
BHA Medical’s VitalStream solution focuses on integrating this level of monitoring into acute care workflows, streaming real-time data to a centralised platform, supporting earlier recognition of deterioration and more informed clinical decision-making.
In corridor medicine, where patients are often managed outside traditional monitored spaces, the challenge is missed deterioration between spot checks. Continuous trending helps reduce those “blind spots,” enabling earlier identification of haemodynamic decline and better prioritisation when systems are under pressure.
And in pre-hospital care, the value is in maintaining a clear physiological narrative from first patient contact through to hospital handover. VitalStream is designed for rapid deployment, applied, calibrated, and delivers data within around 90 seconds, using a low-pressure finger sensor that allows teams to follow trends in real time, rather than relying on isolated snapshots.
For more information, visit: https://www.bha-medical.com/vitalstream-patient-monitoring