Pre-Hospital Care Podcast

Today on the Pre-Hospital Care Podcast, the discussion opens with a critical question: why do even highly trained clinicians struggle to perform under pressure, and what can be done about it? To explore this, we are joined by Dr Stephen Hearns, a globally respected clinician, educator, and author whose work bridges emergency medicine, human performance science, and high-stakes decision-making.
Stephen is a consultant in emergency and aeromedical retrieval medicine and played a central role in developing Scotland’s Emergency Medical Retrieval Service (EMRS), a government-funded critical care retrieval organisation delivering advanced pre-hospital care to major trauma patients and those with complex critical illness in remote environments.
Drawing on his book Peak Performance Under Pressure, Stephen examines the cognitive and behavioural factors that influence performance in extreme conditions. This episode focuses on practical strategies, including mental rehearsal, shared mental models, and cognitive aids, and how these translate into sharper decision-making and improved outcomes in real-world pre-hospital care.
Further reading relevant to this episode from Stephen can be found here:
https://corecognition.co.uk/blog/the-arc-of-performance
Learn more about Core Cognition:
https://corecognition.co.uk/

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/⁠

Grief is an inevitable part of pre-hospital care, yet it remains one of the most complex and challenging aspects of our work. In this compilation episode, we bring together three powerful conversations exploring grief, bereavement, loss, and the role healthcare professionals play in supporting patients, families, and themselves during some of life's most difficult moments.
We begin with renowned psychotherapist and author Julia Samuel, who shares insights from more than three decades of working with bereaved families. Alongside Caroline Phillips, Julia explores the process of grief and bereavement, the skills required for breaking bad news, the impact of repeated exposure to loss on healthcare professionals, and practical approaches to building resilience in emotionally demanding roles.
The episode then turns to a two-part conversation with grief specialist Liz Gleeson. In Part 1, we explore key theories and frameworks for understanding grief, including Attachment Theory, Continuing Bonds, the Dual Process Model, and Kübler-Ross's Five Stages of Grief. Liz discusses the importance of presence, listening, cultural awareness, and compassionate care, while also examining the emotional toll that supporting grieving individuals can have on clinicians.
In Part 2, we take a deeper look at the many forms grief can take beyond bereavement. Together, we explore anticipatory grief, perinatal loss, suicide bereavement, parental and sibling grief, losses associated with ageing, and the often-overlooked impact of divorce, separation, and family estrangement. We also discuss disenfranchised grief and how recognising these experiences can help pre-hospital professionals provide more sensitive, informed, and person-centred care.
Whether you are supporting families through sudden loss, caring for patients facing life-limiting illness, or reflecting on your own experiences of grief and exposure to trauma, this compilation offers practical insights, evidence-informed perspectives, and compassionate guidance for navigating one of the most universal aspects of human experience.
Guests:
Julia Samuel MBE – Psychotherapist, Founder Patron of Child Bereavement UK, and author of Grief Works and This Too Shall Pass.
Liz Gleeson – Creator of the Shapes of Grief podcast and internationally recognised grief educator and therapist.

This episode is essential listening for anyone working in pre-hospital, emergency, critical care, or healthcare environments where grief and loss are encountered as part of everyday practice.

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/⁠

Today’s guest is Kodey Bogart, a pilot whose career bridges frontline combat aviation and the demanding, safety-critical environment of civilian helicopter operations. Dr. Kodey Bogart, AvD., is a former United States Army Warrant Officer and aviator who flew the Black Hawk on medical evacuation missions. A decorated combat veteran, she has been awarded two Air Medals and the prestigious Sikorsky Rescue Award. She also made history as the first female Pilot in Command in the Florida Army National Guard, qualified for day, night, and night vision goggle (NVG) combat operations.
Kodey’s experience spans aviation safety, flight instruction, maintenance, test flying, Helicopter Emergency Medical Services (HEMS), and aviation law enforcement. She brings both technical depth and operational insight to every mission she undertakes.
In this episode, we explore the realities behind high-stakes decision-making in HEMS, how crews manage risk under pressure, where safety systems hold up or fall short, and what pilots and clinicians can learn from each other in critical moments.
Beyond aviation, Kodey contributes to public service through Operation Helo, a charity addressing gaps in disaster response, and is the author of a children's book series introducing young readers to various aviation missions, including air ambulance. Both can be found here:
Kodey's children's book on Air Ambulance helicopter pilots can be found here: ⁠https://www.helogirls.com/⁠
Operation Helo: https://www.operationhelo.org/⁠

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 this episode, we are joined by Dr Ina Schmidt, Consultant Anaesthetist, Intensivist, Flight Physician, and President of ICARUS e.V., to examine what truly changes when critical care leaves the ground. Drawing on extensive experience at the intersection of intensive care and aviation medicine, Dr Schmidt discusses why aeromedical medicine should be regarded as a distinct speciality rather than simply “EMS in the sky.”
Together, we explore the unique physiological and operational challenges of patient care at altitude, from hypobaric hypoxia and environmental stressors to the complexities of monitoring critically ill patients in confined, high-noise environments. We also examine the future of in-flight critical care, including the broader evolution toward continuous, wireless, non-invasive haemodynamic monitoring and how emerging technologies may reshape the delivery of intensive care in the air.
ICARUS (International Community for Aeromedical Research and Universal Standards) is an international professional association dedicated to advancing aeromedical transport medicine through research, education, quality improvement, and the development of evidence-based standards. Based in Germany, the organisation brings together clinicians, researchers, educators, and industry leaders to improve patient safety and outcomes during air medical transport. ICARUS promotes a patient-centred approach to critical care transport and retrieval medicine, supports collaborative research and audits, develops educational programmes and certifications, and advocates for the recognition of aeromedical transport medicine as a specialised medical discipline. Through its global network, webinars, conferences, committees, and academic partnerships, ICARUS aims to establish universal standards that enhance the quality and safety of aeromedical operations worldwide. More can be found here: https://icarus-aeromedical.org/

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

Neurodiversity is something paramedics encounter every day, whether we consciously identify it or not. It is present in the child who will not tolerate the blood pressure cuff, the adult who cannot answer questions in sequence, or the patient who appears agitated under blue lights but settles in a quiet room. Autism and ADHD are not rare edge cases; they are common neurodevelopmental differences that shape how people process information, regulate emotion, experience sensory input, and respond to stress.
Both are frequently hidden. Many adults remain undiagnosed. Others mask extensively, particularly in public or professional settings, meaning the first time their coping strategies fail may be during illness, injury, or crisis. In the pre-hospital environment, defined by urgency, noise, bright lighting, unfamiliar touch, and compressed decision-making, those coping mechanisms can collapse quickly. What follows may look like resistance, inconsistency, hostility, or disengagement. In reality, it is often cognitive overload or dysregulation.
Autism and ADHD also overlap significantly. Executive dysfunction, sensory sensitivity, communication differences, emotional lability, and difficulties with working memory can coexist. For paramedics operating under time pressure, rapid behavioural interpretation becomes almost automatic: cooperative or not, intoxicated or sober, compliant or difficult. When neurodivergence is not considered, behaviour is framed as intentional rather than neurological.
Today on the Pre-hospital Care Podcast, I’m joined by David Birch to unpack this in practical terms. We explore how ADHD and autism actually present on scene, beyond stereotypes, and why behaviours such as poor eye contact, restlessness, blunt communication, or inconsistent histories are so often mislabelled as non-compliance or intoxication. We examine the clinical risk of those assumptions, from premature diagnostic closure to inappropriate use of sedation or restraint.
Most importantly, we discuss what paramedics can do differently. Not complex protocols or lengthy interventions, but small, deliberate, patient-centred adjustments: simplifying language, reducing sensory load where possible, allowing processing time, offering clear structure and predictability, and reframing behaviour through a neurodiversity-informed lens.
You can see more from David's lectures on YouTube here: https://www.youtube.com/watch?v=CkzXbjG7uiY&t=594s