Pre-Hospital Care Podcast

Today, we’re joined by Diane Dollar, a pilot whose career sits at the intersection of frontline HEMS operations, training, and the future of the aviation workforce. Diane is a professional helicopter pilot and check airman for a major air medical operator, with a background that spans tours, VIP charter, organ transport, and helicopter air ambulance missions. Alongside this, she continues to fly electronic news gathering, bringing a broad operational perspective across high-pressure, real-world operations. 
Her aviation journey began in the U.S. Coast Guard, where exposure to search and rescue missions sparked a passion for flight, ultimately leading to more than a decade in the cockpit across diverse mission sets. But Diane’s impact extends well beyond flying. As the founder of Forever on the Fly, she’s building pathways into aviation through mentorship, STEM engagement, and large-scale “Dare to Dream” events, designed to inspire the next generation and address the lack of diversity in the cockpit. 
In this episode, we explore what that breadth of experience means for HEMS: decision-making under pressure, the realities of operational risk, and how culture, mentorship, and training shape safer, more effective crews.

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/⁠

Fatigue is one of the most significant yet under-recognised threats to safety in pre-hospital care. Every day, ambulance clinicians make complex clinical decisions, drive emergency vehicles, and care for critically ill patients while working long shifts, overnight hours, and often with inadequate recovery. Despite decades of evidence demonstrating the impact of fatigue on cognitive performance, decision-making and patient safety, healthcare has traditionally relied more on individual resilience than organisational systems designed to manage fatigue risk.
In this special compilation episode of the Pre-Hospital Care Podcast, we bring together two complementary conversations that explore not only what fatigue does to clinicians and patients, but also how ambulance services can begin addressing it through evidence-based practice.
We begin with Kristy Sanderson, whose work leads the ambitious CATNAPS programme. Drawing on lessons from aviation and other safety-critical industries, Kristy's research is developing a comprehensive Fatigue Risk Management System (FRMS) specifically designed for NHS ambulance services. We explore why current approaches often lack an empirical foundation, how CATNAPS is identifying interventions that are both acceptable and feasible, and what implementation could look like across the UK ambulance sector. The discussion also examines fatigue reporting, organisational culture, the realities of 12-hour shifts, fatigue mitigation strategies, and the wider consequences of fatigue for clinicians, patients and healthcare organisations.
In the second half of the episode, we're joined by Professor Daniel Patterson, one of the world's leading researchers in EMS fatigue science. Daniel explains the landmark Fatigue in EMS Project and the systematic reviews that informed the first evidence-based fatigue guidelines for EMS. Together, we explore the evidence surrounding shift length, strategic napping, caffeine, education, workload, fatigue modelling and why fatigue should be considered a systems-level patient safety issue.
Together, these conversations provide a comprehensive overview of both the implementation and the science of fatigue risk management, offering practical insights for clinicians, operational leaders, educators and researchers working to improve safety within 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 ⁠https://www.pax-bags.com/en/⁠

Cardiac arrest remains one of the most scrutinised and resource-intensive presentations in prehospital care. We invest heavily in improving what happens in the moment, compression quality, airway strategies, defibrillation timing, and team coordination. Yet one of the most powerful determinants of system performance often sits outside the resuscitation itself: what we do with the data afterwards.
In many services, once the patient is handed over or resuscitation is terminated, the process effectively stops. Information is fragmented, device data is reviewed inconsistently, and structured debriefing is applied variably. As a result, opportunities to identify system errors, reinforce high performance, and drive meaningful quality improvement are frequently lost.
At the same time, prehospital systems are generating more data than ever before CPR metrics, rhythm timelines, drug administration logs, and physiologic trends. The challenge is no longer collection, but conversion: turning raw resuscitation data into actionable learning. Layered on top of this is an emerging opportunity to deliver meaningful information to hospitals in real time, supporting earlier decision-making in the ED and cath lab before the patient even arrives.
In this episode, we explore how structured debriefing, post-arrest analysis, and improved data integration could transform cardiac arrest care from a series of isolated events into a continuous learning system spanning prehospital teams and receiving hospitals.
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 of the Pre-Hospital Care Podcast, we're joined by Dr Jo Mildenhall to explore a critical and often under-discussed issue in pre-hospital medicine: burnout.
Frontline ambulance staff experience some of the highest rates of sickness absence in the NHS, with stress, anxiety, and depression frequently cited as the cause. While much attention has traditionally focused on the impact of major traumatic incidents, Jo's research has consistently challenged this narrative, highlighting that the cumulative burden of daily hassles, operational pressures, organisational friction, resource constraints, moral distress, and relentless demand may be equally, if not more, damaging to psychological wellbeing.
Drawing on her latest work on the social psychological dynamics within ambulance service culture, Jo examines how group identity, workplace relationships, and collective experiences of adversity shape the way ambulance clinicians perceive, process, and respond to stress and trauma. Her research suggests that the cultures we work within profoundly influence our emotional responses, coping behaviours, and willingness to seek support. We unpack the informal coping mechanisms paramedics often turn to, including cognitive strategies, gallows humour, and peer support, and examine what it is about these strategies that they find particularly helpful.
With Jo's extensive experience in both clinical and educational settings, we reflect on how workplace culture, leadership, social identity, and peer relationships shape how paramedics manage stress, and what more can be done to protect psychological wellbeing on the front line. Ultimately, this episode asks an important question: if burnout is driven as much by the accumulation of everyday pressures as by extraordinary events, how do we build ambulance services that are not only operationally effective but also psychologically sustainable?
Please find Jo's latest research here: https://www.researchgate.net/publication/272449530_Occupational_stress_paramedic_informal_coping_strategies_a_review_of_the_literature

On the Pre-Hospital Care Podcast, we spend a lot of time discussing clinical decision-making, operational challenges, and the science that underpins emergency medicine. But now and again, it's important to step back and remember why we do what we do. Behind every dispatch is a person. Behind every set of observations is a family. And behind every successful mission is a story that often continues long after the helicopter has landed and the ambulance has left.
Today's guest is Shane Bradley. On the 27th of July 2025, what began as an ordinary day quickly became a fight for survival when Shane suffered a heart attack. Thanks to the rapid response of the emergency services, including the Devon Air Ambulance, he was transported to definitive care. His consultant later told him something few patients ever hear: that the helicopter almost certainly made the difference between life and death.Nearly a year later, Shane isn't simply reflecting on what happened. He's determined to give something back. To mark the anniversary of what he calls his "second chance at life," he's embarking on an extraordinary challenge: riding his motorcycle 1,000 miles in under 24 hours to raise funds for the charity that helped save him.
This is a conversation about survival, gratitude, recovery, and the profound impact that pre-hospital care can have, not just on a patient's outcome, but on the rest of their life. To give to Shane's challenge for Devon's Air Ambulance, please see here: https://www.justgiving.com/page/shanes1000mileride