Pre-Hospital Care Podcast

Resuscitation is often seen as individual performance, but cardiac arrest care is ultimately a system outcome, shaped by training, communication, leadership, feedback, and the systems supporting the team.
In this three-part debriefing series, I’m joined by David Hiltz as co-host, and in this first episode, Ann Doll from the Resuscitation Academy, to explore how high-performing systems turn resuscitation events into opportunities for learning and sustained improvement.
We explore how structured debriefing can create a feedback loop between frontline experience and organisational improvement, and how to build a culture where learning is routine rather than optional. We also examine lessons from aviation and other high-performance environments, where debriefing, safety reporting and incident analysis turn individual experiences and near misses into organisational learning.
If learning stays with one crew, the system learns very little. If it is captured, shared and translated into changes in training, processes or system design, one event can improve performance across an entire organisation.

Practical resources for debriefing and resuscitation improvement:
Resuscitation Academy — Ann Doll
The Resuscitation Academy provides a substantial library of free, practical resources for improving cardiac arrest systems and performance. Resources include e-books, toolkits, high-performance CPR materials, T-CPR resources, CARES resources, community CPR and PAD resources, as well as a free Cardiac Arrest System Self-Assessment.
ThriveIn — Bridgid Joseph
ThriveIn provides healthcare consulting and educational resources focused on quality improvement, staff education, patient safety, emergency cardiovascular care and innovation. Resources also include work relating to mock codes and improving cardiac arrest response.
360 Leadership Group — John Hiltz
The 360 Leadership Group provides resources and perspectives on high-performance teams, leadership, communication, preparation and debriefing, drawing heavily from the experience of former Blue Angels pilots and other high-performance environments.
Structured and Supported Debriefing
The Structured and Supported Debriefing Script provides a practical Gather → Analyze → Summarize approach. It includes facilitator questions designed to understand what happened, explore why it happened, identify what went well and what needs improvement, and support the team in identifying its own learning.
AHRQ TeamSTEPPS — Debriefing
The AHRQ TeamSTEPPS Debrief is one of the most immediately usable healthcare debriefing resources. It includes a debriefing checklist covering communication, roles, situational awareness, workload, resources, what went well and what could be improved. AHRQ also provides a short video demonstrating an emergency-department debrief.
FEMA — After-Action Review
The FEMA After-Action Review resources provide a more comprehensive approach to reviewing significant events. The AAR User Guide covers preparation, data collection, analysis, findings and improvement actions, alongside templates and tools for tracking whether recommended actions are completed.
NASA — Crew-Centered Debriefing
The NASA Guidelines for Facilitating Debriefings provide valuable insight from aviation human-factors research. The approach emphasises crew participation, self-discovery, effective questioning and facilitation rather than simply lecturing the team. This is particularly relevant to the idea that a facilitator's role is to help the team discover and articulate its own learning.
NASA Aviation Safety Reporting System — CALLBACK
The NASA ASRS CALLBACK provides a remarkable collection of real-world aviation lessons. Using de-identified safety reports and commentary, CALLBACK explores communication, decision-making, teamwork, human factors, and operational risk. It offers an excellent example of how individual experiences can be transformed into organisational learning.

Decision-making is one of the defining skills of pre-hospital practice. Every shift requires clinicians to interpret incomplete information, navigate uncertainty, balance competing risks, and make consequential decisions, often under intense time pressure. But does faster decision-making necessarily lead to better decisions?
In this compilation episode of the Pre-Hospital Care Podcast, we explore the anatomy of decision-making under pressure, examining the cognitive processes, mental models, and human factors that influence how emergency responders think, assess, and act.
We explore the limits of working memory through Miller’s Magic Number 7, the role of heuristics and intuition, inattention bias, cognitive overload, and the critical role of metacognition in recognising and improving our own decision-making. We also consider how stress, leadership, teamwork, experience, and limited resources shape decisions when the stakes are high.
Featuring insights from Olly Sapsford, Firefighter, Commander and Lecturer in Disaster & Emergency Management at Coventry University, alongside discussion of Radu Venter’s research into EMS decision-making, this compilation challenges the culture of constant urgency in emergency medicine and asks whether rushing decisions actually makes us better clinicians.
From the fireground to the ambulance and the clinical environment, we examine the OODA Loop, reflective practice, expertise, ethical decision-making, and the potential for technology and artificial intelligence to support, not replace, human judgement.
Ultimately, this episode asks a fundamental question: what does it take to make sound, timely, and patient-focused decisions when every decision counts? These are the individual episodes:
The Anatomy of Decision Making Under High Pressure Situations
Listen on Apple Podcasts
Decision-Making Under High Pressure Situations – Part 2 with Olly Sapsford
Listen on Apple Podcasts
EMS Decision-Making: Rushing the OODA Loop with Radu Venter
Listen on Apple Podcasts

In this episode, I’m joined by Neil Jeffers to explore Crew Resource Management (CRM) and why it remains one of the most important safety tools in aviation, healthcare, and pre-hospital care.
We begin by tracing the origins of CRM, examining how a series of aviation accidents shifted the focus from technical proficiency alone to the human factors that influence decision-making, communication, leadership, and teamwork.
Together, we discuss the relationship between human factors and CRM, exploring how errors occur, why even highly experienced professionals are vulnerable to them, and how effective teams recognise and manage threats before they lead to adverse outcomes. We also examine Threat and Error Management (TEM), the practical framework that underpins much of modern CRM, and consider how these principles apply in the dynamic and often unpredictable environments of HEMS, search and rescue, and pre-hospital medicine.
Neil brings a unique perspective, having accumulated over 8,000 flying hours, served as Chief Pilot for London’s Air Ambulance, worked as a CRM instructor and first responder, and now supporting Irish Coast Guard search and rescue operations.

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, 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/⁠