Pre-Hospital Care Podcast

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

In this special three-part series, we move beyond the acute management of cardiac arrest and into the far less frequently discussed phase of survival: what comes after return of spontaneous circulation. While clinical focus often centres on early defibrillation, high-quality CPR, and post-resuscitation care, these episodes explore a different but equally important question: what does recovery actually look like for patients and families once they leave the resuscitation bay?
Across three conversations, we hear from survivors whose cardiac arrests occurred in dramatically different contexts, yet whose recovery journeys share striking common themes: uncertainty, identity change, psychological impact, and the long shadow of a life-threatening event. We also explore the role of bystanders, pre-hospital clinicians, and system-level coordination in shaping not only survival, but long-term outcomes.
In Part 1, Paul Swindell reflects on his sudden cardiac arrest in 2014, the immediate pre-hospital response, and the complex recovery that followed. Paul discusses the physical rehabilitation process alongside the less visible psychological challenges, including adjustment to a new baseline of health and the development of advocacy work through Sudden Cardiac Arrest UK.
https://podcasts.apple.com/ee/podcast/surviving-cardiac-arrest-part-1-paul-swindell-and/id1441215901?i=1000680776156
In Part 2, Zoe Hitchcock shares her experience of a cardiac arrest in central London caused by underlying cardiomyopathy, resulting in ventricular fibrillation. Zoe walks through the events leading up to her collapse on Oxford Street, the coordinated pre-hospital response, including HEMS involvement, and her transfer to St Mary’s Hospital. She reflects on the long-term emotional impact, shifts in perspective, and the way her understanding of family, health, and resilience has evolved since the event.
https://podcasts.apple.com/de/podcast/surviving-cardiac-arrest-part-2-zoe-hitchcocks-story/id1441215901?i=1000681711888
In Part 3, Noah Baron Cohen, joined by his father Erran Baron Cohen, recounts a sudden collapse during exercise at school in North London in 2016. The episode reconstructs the timeline from initial collapse through resuscitation, emergency response, and subsequent hospital care. Erran provides a parallel perspective as a parent navigating the immediate crisis and the prolonged rehabilitation journey that followed. Together, they explore recovery, family impact, and the enduring psychological and emotional consequences of sudden cardiac arrest.
https://podcasts.apple.com/us/podcast/surviving-cardiac-arrest-with-noah-and-erran/id1441215901?i=1000567431898
Taken together, these episodes reinforce a central principle of resuscitation medicine: survival is a system outcome. Yet beyond the system lies the individual experience, complex, non-linear, and often underrepresented in clinical discourse. This series aims to bridge that gap by bringing survivor voices into the foreground of the cardiac arrest narrative.

In pre-hospital care, few diagnoses carry the same urgency as stroke. But not all strokes present the way we expect, and that’s where the risk lies. In this episode, we explore the challenge of recognising posterior circulation strokes, using both clinical insight and lived experience. I’m joined by Shane Devlin, a registered paramedic and newly appointed PhD researcher focusing on posterior stroke recognition. His work builds on frontline experience and a growing body of evidence that highlights just how easily these patients can be missed.
Alongside Shane, this conversation is grounded in a personal story: my brother, Ronan Walker, who suffered a posterior stroke 4 years ago in his late 30's. His presentation didn’t fit the traditional mould. There was no clear FAST-positive picture, just subtle, evolving symptoms that required a different kind of clinical suspicion.
This episode sits at the intersection of science and story. We unpack the limitations of current assessment tools, the cognitive challenges clinicians face in the field, and what needs to change to improve recognition. Because in a posterior stroke, the issue often isn’t treatment, it’s getting patients to treatment in time.
Shane has published both case studies and qualitative research on PCS. Both can be found here: Paramedic recognition of posterior circulation stroke: a vignette and focus group study
https://pubmed.ncbi.nlm.nih.gov/37674916/

Not so FAST: pre-hospital posterior circulation stroke:
https://pdfs.semanticscholar.org/06a1/f16d9062708b6f4ff8bb29efb7d9a61b43db.pdf

⁠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/⁠

Airway management remains one of the most critical and technically demanding aspects of pre-hospital care. In this special Pre-Hospital Airway Compilation, we bring together leading voices in airway management to explore the fundamentals, controversies, and high-stakes realities of managing the airway outside the hospital environment.
Across these conversations, we move from airway assessment and respiratory evaluation through to advanced interventions including rapid sequence induction, Suction Assisted Laryngoscopy and Airway Decontamination (SALAD), and Front of Neck Access (FONA). We examine the challenges unique to the pre-hospital environment, discuss practical approaches to decision-making under pressure, and explore where clinicians fit into a stepwise airway management strategy—from optimisation and monitoring all the way through to invasive surgical techniques.
Joining us first is John Chatterjee. John is a Consultant Anaesthetist with interests in pre-hospital care, difficult airway management, thoracic anaesthesia, and high-risk anaesthesia.
Alongside John, we are joined by Cliff Reid, a retrieval physician with more than two decades of experience across air ambulance and critical care transport services. This episode aims to provide practical insights into one of pre-hospital medicine’s most challenging and consequential interventions.

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/⁠

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

In pre-hospital care, timing isn’t just important; it’s everything. The difference between a good outcome and a devastating one can come down to minutes and decisions, and few decisions are more critical than knowing when to bring advanced critical care to the scene.
In this episode, we’re joined by Critical Care Paramedic Callum Sutton from Great Western Air Ambulance Charity (GWAAC) to explore a question that sits at the heart of pre-hospital medicine: when does HEMS truly add value? This isn’t about calling early for the sake of it; it’s about understanding the patients, the physiology, and the interventions that can change trajectories.
But just as important is what happens before the helicopter lands. From optimising access and monitoring to anticipating procedures like pre-hospital emergency anaesthesia, small actions on the ground can translate into critical time saved. This is a conversation about foresight, teamwork, and marginal gains, and how, in the right moments, those gains can mean everything.

This episode is supported by the Great Western Air Ambulance Charity (GWAAC).
GWAAC’s Clinical Symposium takes place on Friday, 16 October 2026, at Ashton Gate Stadium, Bristol, with this year’s theme: Innovation. The event will focus on practical, implementable ideas shared by GWAAC’s Critical Care Team and guest speakers, designed for clinicians to take directly back into practice and apply quickly, rather than years down the line.
Limited availability: ~120 tickets only
Tickets on sale from June 2026
Early interest sign-up is available now
Also includes updates on other GWAAC clinical engagement events
Find out more and register interest: https://gwaac.com/symposium

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/⁠