Pre-Hospital Care Podcast

Professor David K. Menon joins us for an in-depth exploration of Traumatic Brain Injury (TBI). As the Founding Director of the Neurosciences Critical Care Unit at Addenbrooke’s Hospital, Professor Menon has been instrumental in shaping modern understanding of TBI physiology, monitoring, and management.
In this episode, we break down intracranial pressure physiology in a way that translates directly to roadside decision-making, examining how brain swelling, cerebral perfusion, and autoregulation respond to early interventions. We focus on hypotension and hypoxia, the two most powerful drivers of secondary brain injury, and why the pre-hospital phase represents a critical window to influence outcomes long before CT imaging or neurosurgical care.
We also explore the evidence for pre-hospital hypertonic therapy, discussing when it may be beneficial, where its limitations lie, and how it should (and should not) fit into contemporary practice. Practical considerations around airway management and ventilation are covered, including CO₂ targets, RSI decision-making, and strategies to avoid iatrogenic harm.
Finally, we look ahead to emerging research and evolving concepts in TBI care, new physiological insights, changing targets, and innovative approaches aimed at reducing secondary brain injury, highlighting what pre-hospital clinicians should be thinking about now and in the years to come.
Relevant resources and research networks:
TBI-Reporter: https://tbi-reporter.uk/
CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI): https://www.center-tbi.eu/
This episode is essential listening for anyone involved in pre-hospital, retrieval, or critical care treating patients with traumatic brain injury. You can see more from David here: https://www.youtube.com/watch?v=7PhIGMpEpGQ

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In this episode, Laura Hall addresses the often-overlooked impact of secondary trauma on emergency responders and healthcare professionals, emphasising the need for meaningful mental health support and long-term resilience. Drawing on personal experience, the discussion challenges the effectiveness of traditional debriefing models, highlighting how well-intentioned but poorly designed institutional processes can fail staff working in chronically high-stress environments.
The conversation explores the consequences of this gap in support, including burnout, moral injury, and workforce attrition. To counter these trends, Laura introduces practical, accessible frameworks such as the Stress Continuum and the 3-3-3 Protocol. These tools provide clinicians with a shared language and structure to recognise early warning signs of psychological strain and to intervene before distress escalates.
A key theme is the concept of making green choices, small, proactive decisions that support recovery, regulation, and psychological safety following traumatic incidents. Rather than relying solely on post-incident interventions, the emphasis is on ongoing self-monitoring, peer support, and normalising conversations about mental wellbeing.
Ultimately, this episode calls for a cultural shift within organisations: from reactive, checkbox approaches to mental health, towards environments that prioritise emotional safety, mutual care, and staff retention through structured, evidence-informed support systems. You can read the blog here: https://highadventurehealthcare.substack.com/p/building-resiliency-in-responders

This Podcast is sponsored by World Extreme Medicine.
World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.
With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In this episode, Alec Wilding is joined by Nikki Hewitt, a clinician who has been among the first Paramedics in the United Kingdom to deliver pre-hospital ECMO as part of London’s Air Ambulance (LAA), Endovascular Cardiac Arrest Team, known as ECAT. This represents one of the most significant steps forward in resuscitation science within the pre-hospital environment, and Nikki has been at the centre of that evolution.
During the conversation, Nikki guides us through the evidence base underpinning ECPR, exploring what we currently know, what remains uncertain, and how ongoing research continues to shape clinical decision-making. She also takes us inside the operational structure of the ECAT model, how the team was established, what it takes to deliver ECMO in the field, and the training, skill sets, and logistics required to make it viable outside the hospital walls.
Nikki also shares her perspective on where ECPR is heading: The challenges, the opportunities, and what the future of advanced pre-hospital cardiac arrest care may look like as technology, capability, and evidence continue to advance. It is a fascinating area of practice, and Nikki brings frontline insight, experience, and clarity to a topic that is reshaping the conversation around survivability in cardiac arrest.
This Podcast is sponsored by World Extreme Medicine.
World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.
With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In this episode, Alec Wilding is joined by Nikki Hewitt, a clinician who has been among the first Paramedics in the United Kingdom to deliver pre-hospital ECMO as part of London’s Air Ambulance (LAA), Endovascular Cardiac Arrest Team, known as ECAT. This represents one of the most significant steps forward in resuscitation science within the pre-hospital environment, and Nikki has been at the centre of that evolution.
During the conversation, Nikki guides us through the evidence base underpinning ECPR, exploring what we currently know, what remains uncertain, and how ongoing research continues to shape clinical decision-making. She also takes us inside the operational structure of the ECAT model, how the team was established, what it takes to deliver ECMO in the field, and the training, skill sets, and logistics required to make it viable outside the hospital walls.
Nikki also shares her perspective on where ECPR is heading: The challenges, the opportunities, and what the future of advanced pre-hospital cardiac arrest care may look like as technology, capability, and evidence continue to advance. It is a fascinating area of practice, and Nikki brings frontline insight, experience, and clarity to a topic that is reshaping the conversation around survivability in cardiac arrest.

This Podcast is sponsored by World Extreme Medicine.
World Extreme Medicine provides internationally recognised education for clinicians and operators working in pre-hospital, remote, expedition, humanitarian, and high-risk environments. Their programmes focus on practical, experience-led learning, equipping professionals with the skills to make sound clinical and operational decisions when resources are limited, evacuation is delayed, and conditions are extreme.
With courses covering expedition and wilderness medicine, hostile environments, dive medicine, human performance, leadership, and austere care, World Extreme Medicine brings together a global faculty with real-world experience from some of the most challenging settings on earth. To explore courses, free educational resources, and upcoming webinars, visit: ⁠www.worldextrememedicine.com

In the final episode of our three-part series marking the anniversary of the 7/7 London bombings, we hear from paramedic Sam Sinclair, who was deployed to Tavistock Square following the fourth and final explosion. This episode brings the series to a close by focusing on the realities of frontline decision-making at a major incident scene and the lasting impact such experiences have.
Sam recounts arriving at a scene of profound devastation, rapidly assessing risk, and making critical, time-pressured decisions in an environment defined by uncertainty and loss. In conversation, he reflects on the lessons 7/7 taught him about teamwork, professional instinct, and leadership under pressure, as well as how to carry the emotional and psychological weight of a major incident across a sustained career in emergency medicine.
Content Warning: This episode contains detailed and graphic descriptions of traumatic injuries, death, and first-person reflections on the 7/7 bombings. Listener discretion is strongly advised.
The views and opinions expressed in this podcast are those of the individual speakers and do not necessarily reflect the views, policies, or positions of any affiliated organizations, employers, professional bodies, or regulatory authorities.
The content discussed is intended for educational and informational purposes only. It does not constitute medical advice, clinical guidance, or a substitute for formal training, local protocols, or independent clinical judgment.
Clinical decisions should always be made in accordance with current evidence, local guidelines, the scope of practice, and consultation with appropriately qualified healthcare professionals. Listeners are responsible for ensuring that any application of information discussed is appropriate to their own clinical context.