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The St.Emlyn’s Podcast: Daily Summaries Delivered
by St Emlyn’s Blog and Podcast
St Emlyn’s is the premier emergency medicine podcast from the UK. We discuss evidence based medicine, clinical excellence, wellbeing and the philosophy of emergency care.
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- 2 weeks ago33 min
Ep 294 - Experts Are Made, Not Born: Sara Crager on Mental Models and Rapid Sequence
What does it really mean to become an expert in resuscitation and critical care? It is tempting to think that expertise comes from accumulating enough facts, passing enough exams or simply spending 10,000 hours at work. In this episode, Iain Beardsell is joined by emergency physician, intensivist and medical educator Sara Crager to explore why expertise is less about how much we know and more about how we think. Sara explains how experts develop high-quality mental models that allow them to organise information, recognise patterns and approach difficult clinical problems. Crucially, these mental models do not have to remain hidden inside the heads of experienced clinicians: they can be identified, explained and deliberately taught. The conversation moves from the limitations of mnemonics and assessment-driven education to the value of deliberate practice, feedback and safe failure. Sara describes how an expert might organise the differential diagnosis of cardiac arrest into respiratory, haemodynamic and metabolic problems, rather than relying solely on a memorised list of Hs and Ts. Iain and Sara then discuss Rapid Sequence, the gamified clinical-learning platform Sara created with emergency physician Ryan Ernst. Learners work through realistic cases in a simulated clinical environment, managing several patients while dealing with interruptions, competing priorities and the consequences of their decisions. After each block, Sara and Ryan deconstruct the cases, make their clinical reasoning explicit and introduce mental models that learners can immediately apply when they try again. It is a cycle of practice, failure, teaching and repetition—without putting a real patient at risk. They also explore why attention, storytelling and visual design matter in medical education; how “multitasking” may be better understood as rapid task switching; and what Sara has learned from turning an educational passion project into a working product. In this episode Why expertise is about cognitive strategies and mental models—not simply knowledge Why experts are made rather than born The limitations of the “10,000-hour rule” How deliberate practice differs from repetition When learners are ready to be taught expert ways of thinking Foundational knowledge versus clinically useful organisation Moving beyond mnemonics such as the Hs and Ts How experts can make their implicit reasoning explicit Why acquiring a new mental model can produce a sudden leap in performance The importance of inspiration—and giving learners an achievable pathway How Rapid Sequence creates a safe place to make mistakes Managing several patients, interruptions and cognitive load Teaching shock, respiratory failure and acid–base physiology Why engaging design is part of the educational method The role of games alongside podcasts, lectures and clinical experience Reframing multitasking as rapid task switching The “pause and bookmark” technique for managing interruptions The realities of building an independent medical-education project Why partnership, persistence and a genuine belief in the project matter Learning from podcasts? If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.
- Jun 27, 202617 min
Ep 293 - Making Feedback Sticky, TTL Tips and more (February 2026 round up)
In this episode of the St Emlyn’s Podcast, Iain Beardsell and Simon Carley catch up on the February blog posts, recorded in the rather unseasonal context of a UK heatwave. They begin with congratulations to Simon on his reappointment as Dean of the Royal College of Emergency Medicine, before reflecting on recent conferences including IFEM in Hamburg and Don’t Forget The Bubbles in Glasgow. The clinical focus this month is trauma team leadership, with practical tips on interpreting trauma CT reports, maintaining momentum after the scan, performing safer log rolls, and making feedback more useful for learners and colleagues. Key learning points Look at trauma CT images yourself as part of your own clinical learning and to integrate the scan with your examination findings. Treat the first CT report as a primary survey, not necessarily a definitive final report. Speak to the radiologist and share clinical concerns or uncertainties. Do not lose momentum after CT; this is a vulnerable phase in trauma care. Log rolls should have a purpose and should minimise movement, pain and physiological risk. Use clearer team communication: “Is anybody not ready to move?” and “ready, steady, move.” Feedback sticks when it is specific. Add “because” to positive feedback so the learner knows exactly what to repeat. Leadership and followership skills apply everywhere, not just in formal trauma team leader roles. Learning from podcasts? If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.
- Jun 17, 202621 min
Ep 292 - Leadership, Culture and Psychological Safety in Pre-Hospital Care with Anna Dobbie at Trauma 2030
In this episode of the St Emlyn’s Podcast, Iain Beardsell speaks with Anna Dobbie, consultant in emergency medicine and pre-hospital care, and Clinical Lead for London HEMS. Recorded at Trauma 2030 at the Royal College of Surgeons in London, the conversation explores what it means to lead exceptional teams in one of the most high-pressure areas of emergency medicine. Anna reflects on six years as Clinical Lead for London HEMS, sharing lessons on leadership, culture, psychological safety, difficult conversations, managing strong personalities, and supporting clinicians to do their best work. The discussion also touches on the unique nature of pre-hospital care, where teams move rapidly between downtime and high-intensity clinical decision-making, and where trust, openness and mutual respect are essential. Anna describes the importance of making sure all voices are heard, not just the loudest, and explains why leaders need to be consistent, approachable and willing to have honest conversations when things do not go as well as they should. Anna also reflects on learning leadership on the job, the value of formal leadership training, the challenge of maintaining boundaries when you care deeply about a service, and the relationship between London’s Air Ambulance and its supporting charity. Finally, Iain and Anna look ahead to the future of trauma care and pre-hospital medicine, including research, ECMO, marginal gains, quality improvement, and the continuing ambition to reduce preventable deaths from trauma. Learning from podcasts? If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. Trauma 2030 TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.
- Apr 17, 202634 min
Ep 291 - January 2026 Round-Up: RSI Trial, Trauma Leadership, and the Reality of Corridor Care
In this episode, Iain and Simon catch up on the papers, posts, and conversations that have been sitting with us since the start of the year. Some are familiar. Some are uncomfortable. All of them feel relevant on shift. We start with the RSI trial — ketamine versus etomidate. A study that generated a lot of noise, and perhaps more certainty than it deserved. We move through trauma team leadership. Not as a checklist, but as a set of decisions made under pressure — when to call a Code Red, how to structure a handover, and what it means to lead a team that hasn’t worked together before. There’s a discussion about trauma units. Not the big centres. The places where most patients go. Fewer resources. Different pressures. The same expectations. We talk about spinal cord injury and blood pressure targets. Numbers are useful. But they’re still just numbers. And then corridor care. Not a new problem. But one we may have started to accept in ways that should make us uneasy. We discuss: • What the RSI trial actually showed — and what it didn’t • Why secondary outcomes should make you pause, not pivot practice • How and when to activate a massive haemorrhage protocol • Why early senior decision-making matters more than perfect diagnosis • What good trauma handover looks like — and why it often doesn’t happen • How trauma teams function differently in trauma units • The limits of blood pressure targets in spinal cord injury • Why corridor care is not just operational — but ethical This is not a guideline episode. It’s a conversation about practice. About judgement. About the small decisions that shape outcomes long before the data catches up. If you’re listening after a shift, you’ll recognise most of it. If podcasts are part of how you learn, you can log your listening, reflect, and build CPD through MedPod Learn. It works across podcasts, not just this one. As always, thanks for listening. these ideas are tested in practice. Learning from podcasts? If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.
- Apr 11, 202618 min
Ep 290 - Shock with Rich Carden at Trauma 2030
Shock is one of the most used words in emergency medicine. It’s also one of the most misunderstood. In this episode, recorded at Trauma 2030 at the Royal College of Surgeons, I sit down with one of St Emlyn's own, Rich Carden — former emergency physician, now intensive care trainee and PhD graduate in trauma sciences — to explore what shock actually means beyond the blood pressure reading. We discuss: • Why shock is fundamentally about oxygen delivery and utilisation at a cellular level • The difference between pressure and perfusion • The concept of the “dose” of shock — magnitude and duration • Why haemorrhage may only be the first phase • How trauma patients transition between haemorrhagic, inflammatory, vasoplegic and septic states • The glycocalyx — and why losing it matters • The risks of early vasopressors in an empty system • Why doing the basics exceptionally well remains our best intervention This is not a protocol episode. It’s a physiology conversation. A systems conversation. A reminder that restoring a number is not the same as restoring oxygen to mitochondria. If you’re interested in pre-hospital and trauma systems thinking, do take a look at Tactical Trauma — spaces where these ideas are tested in practice. Learning from podcasts? If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. Trauma 2030 TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide. As always, thanks for listening.
- Mar 20, 202628 min
Ep 289 - Refractory VF, Double Sequential Defibrillation, and the Future of Cardiac Arrest
What do we really know about treating refractory ventricular fibrillation? And why are we still waiting to use strategies that might actually work? In this episode, we talk to Sheldon Cheskes about the evolving science of cardiac arrest, with a focus on refractory and recurrent ventricular fibrillation. We explore the evidence behind double sequential external defibrillation (DSED), how it compares to standard defibrillation, and what the DOSE VF trial has changed in practice. This is not just about adding another shock. It’s about understanding why defibrillation fails, how vector and energy delivery matter, and when a different approach might improve outcomes. We also discuss: The difference between refractory and recurrent VF — and why it matters What DSED and vector change actually do in physiological terms Why guidelines have been slow to move despite emerging evidence The role of antiarrhythmics, adrenaline, and sequence of care Practical considerations for introducing DSED into real systems What comes next — from smarter detection to post-arrest recovery This is a conversation grounded in real-world resuscitation. It challenges current practice without overselling the evidence. Key Learning Points Refractory VF (persistent after multiple shocks) and recurrent VF (returns after ROSC) are distinct clinical problems with different implications Double sequential external defibrillation (DSED) may improve outcomes in refractory VF by altering current pathways and myocardial depolarisation Timing matters — waiting too long to escalate may reduce the chance of success Current guidelines remain cautious, reflecting the balance between evidence and implementation risk Defibrillation strategy is only one part of a complex system that includes high-quality CPR, drug therapy, and post-resuscitation care Why This Matters Cardiac arrest survival remains low. Small improvements in early resuscitation can have large system-wide effects. Understanding when standard care is failing — and what to do next — is where expertise matters. Learning from podcasts? If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. If you are already listening, you may as well make it count.
- Mar 3, 202629 min
Ep 288 - Training Reform, Trauma Leadership, AI on the Shop Floor and more (November/December 2025)
You’re about to hear a conversation that ranges widely — from training reform and trauma leadership to ondansetron, paracetamol protocols, and artificial intelligence. But it isn’t really about any single topic - It’s about where emergency medicine is heading. And whether we are ready for it. This is our November and December 2025 round-up, and revisits the blog posts from the end of last year. A pause. A reset. A chance to look again at ideas that still matter on shift. We explore The Medical Education Training Review and what it might mean for emergency medicine in the UK Flexibility, bottlenecks, and the portfolio route Why culture and team matter more than workload alone Trauma Team Leader tips — from missed wounds to managing presence in the room Ondansetron in paediatric gastroenteritis — symptom control or over-medicalisation? The SNAP protocol for paracetamol overdose in children How long it can take for good data to become everyday practice AI in the consultation room — and what happens when patients arrive with ChatGPT What this means for trainers, medical schools, and the future of clinical judgement This episode closes Season 12 of the St Emlyn’s podcast. Season 13 is coming — including London 2030 content and more from recent conferences. Upcoming events Tactical Trauma returns 2–4 November in Sundsvall, Sweden. It remains one of the most focused and practical trauma meetings in Europe — small faculty, serious discussion, no fluff. If you are interested in pre-hospital and in-hospital trauma care, it is worth your time. IncrEMentuM is approaching fast, with limited places remaining. If you’ve heard us talk about it before, you’ll know why people come back. Learning from podcasts? If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. If you are already listening, you may as well make it count. More conversations from recent meetings — including Trauma 2030 — will follow in upcoming episodes. Thanks for listening
- Feb 24, 202629 min
Ep 287 - Damage Control Pre-hospital Care with Harriet Tucker at Trauma 2030
You’re about to hear a conversation about doing less. But it isn’t really about doing less. It’s about time. Recorded at Trauma 2030 at the Royal College of Surgeons, this episode explores a shift in mindset in pre-hospital trauma care — away from maximal intervention on scene and towards rapid recognition of the patient who cannot be fixed pre-hospital. I’m joined by Harriet Tucker — consultant at London’s Air Ambulance, HEMS Governance Lead at Air Ambulance Kent Surrey Sussex, and Trauma Team Leader at St George’s Major Trauma Centre — to talk about damage control pre-hospital care. We discuss: Using time as a treatment Recognising non-compressible haemorrhage Why one line may be enough Moving interventions into the ambulance Changing the pre-alert The “pit stop” resus Taking patients straight to theatre Cultural resistance to doing less Governance, debrief, and looking after teams This approach focuses on a small but critically unwell group of patients — often penetrating trauma with rapidly exsanguinating haemorrhage — where the only definitive treatment is surgical control of bleeding. The key intervention is speed. Harriet also discusses the governance work behind this change, the importance of reviewing every case, and how to bring ambulance services and in-hospital teams along with the shift in thinking. This episode is part of a series recorded at Trauma 2030. More conversations from the meeting will follow in upcoming episodes. Upcoming events Harriet will be speaking at Tactical Trauma, 2–4 November, Sundsvall, Sweden. IncrEMentuM is now only eight weeks away, with limited tickets remaining. Learning from podcasts? If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing. Trauma 2030 TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.
About The St.Emlyn’s Podcast
St Emlyn’s is the premier emergency medicine podcast from the UK. We discuss evidence based medicine, clinical excellence, wellbeing and the philosophy of emergency care.
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