Pre-Hospital Care Podcast

Paediatric mental health presentations are becoming an increasingly common part of pre-hospital and emergency care. Yet, many paramedics report feeling under-prepared when it comes to recognising and responding to psychological distress in children and adolescents. Unlike physical illness or injury, mental health concerns often present subtly, evolve dynamically, and sit within complex family, social, and developmental contexts.
Today’s guest, Kristina Maximous, is a dual-registered Paramedic with extensive clinical and academic experience in both Australia and the United Kingdom. She currently serves as a Lecturer in Paramedicine and Academic Resourcing Lead and is completing a PhD focused on paediatric mental health screening and assessment within paramedic-led emergency care. Her research has explored how paramedics make decisions about children and adolescents in psychological distress, and the limitations of current screening tools in dynamic, time-pressured environments. Kristina’s work aims to inform more developmentally appropriate, biopsychosocial approaches that support safer, more equitable care for young people. 
In this episode, we explore the distinction between screening and assessment, unpack the challenges paramedics face on the frontline, and discuss what a more holistic, biopsychosocial model might look like in practice. You can find Kristina's scoping review here: https://science-health.csu.edu.au/schools/nursing-paramedicine-health/research/projects/reframing-paediatric-mental-health-screening-and-assessment

Major incidents challenge clinicians to balance speed, simplicity, and clinical effectiveness in highly dynamic environments. In this episode, Advanced Paramedics in Critical Care Keir Rutherford and Alec Wilding reflect on lessons learned from real-world major incidents and the findings of inquiries such as the Manchester Arena bombing. The discussion explores the early recognition of terrorist attacks and how responders can distinguish these events from more routine presentations in the initial stages of a call.
A central theme is triage. Keir and Alec examine the implementation of the new NHS major incident triage framework, including the Ten Second Triage (TST) tool and the Major Incident Triage Tool (MITT). They discuss how these approaches are designed to rapidly identify patients who will benefit most from immediate life-saving interventions, while supporting efficient resource allocation in mass casualty events. The conversation also explores the relationship between triage, enhanced clinical care on scene, and the role of casualty clearing stations.
Joining the discussion is Dr. Philip Cowburn, Consultant in Emergency Medicine and co-author of the Ten Second Triage Tool. Phil shares insights into the evidence underpinning these developments, the influence of recommendations from the Manchester Arena Inquiry, and how national practice has evolved to improve patient outcomes during major incidents.
Beyond clinical processes, the episode highlights the importance of interoperability between ambulance, police, and fire services, alongside the emotional and psychological challenges faced by senior clinicians during and after major incidents. Together, the guests provide a practical and reflective overview of modern major incident management and the evolving systems designed to deliver the greatest benefit to the greatest number of patients.

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 on the Pre-Hospital Care Podcast, the discussion opens with a critical question: why do even highly trained clinicians struggle to perform under pressure, and what can be done about it? To explore this, we are joined by Dr Stephen Hearns, a globally respected clinician, educator, and author whose work bridges emergency medicine, human performance science, and high-stakes decision-making.
Stephen is a consultant in emergency and aeromedical retrieval medicine and played a central role in developing Scotland’s Emergency Medical Retrieval Service (EMRS), a government-funded critical care retrieval organisation delivering advanced pre-hospital care to major trauma patients and those with complex critical illness in remote environments.
Drawing on his book Peak Performance Under Pressure, Stephen examines the cognitive and behavioural factors that influence performance in extreme conditions. This episode focuses on practical strategies, including mental rehearsal, shared mental models, and cognitive aids, and how these translate into sharper decision-making and improved outcomes in real-world pre-hospital care.
Further reading relevant to this episode from Stephen can be found here:
https://corecognition.co.uk/blog/the-arc-of-performance
Learn more about Core Cognition:
https://corecognition.co.uk/

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/⁠

Grief is an inevitable part of pre-hospital care, yet it remains one of the most complex and challenging aspects of our work. In this compilation episode, we bring together three powerful conversations exploring grief, bereavement, loss, and the role healthcare professionals play in supporting patients, families, and themselves during some of life's most difficult moments.
We begin with renowned psychotherapist and author Julia Samuel, who shares insights from more than three decades of working with bereaved families. Alongside Caroline Phillips, Julia explores the process of grief and bereavement, the skills required for breaking bad news, the impact of repeated exposure to loss on healthcare professionals, and practical approaches to building resilience in emotionally demanding roles.
The episode then turns to a two-part conversation with grief specialist Liz Gleeson. In Part 1, we explore key theories and frameworks for understanding grief, including Attachment Theory, Continuing Bonds, the Dual Process Model, and Kübler-Ross's Five Stages of Grief. Liz discusses the importance of presence, listening, cultural awareness, and compassionate care, while also examining the emotional toll that supporting grieving individuals can have on clinicians.
In Part 2, we take a deeper look at the many forms grief can take beyond bereavement. Together, we explore anticipatory grief, perinatal loss, suicide bereavement, parental and sibling grief, losses associated with ageing, and the often-overlooked impact of divorce, separation, and family estrangement. We also discuss disenfranchised grief and how recognising these experiences can help pre-hospital professionals provide more sensitive, informed, and person-centred care.
Whether you are supporting families through sudden loss, caring for patients facing life-limiting illness, or reflecting on your own experiences of grief and exposure to trauma, this compilation offers practical insights, evidence-informed perspectives, and compassionate guidance for navigating one of the most universal aspects of human experience.
Guests:
Julia Samuel MBE – Psychotherapist, Founder Patron of Child Bereavement UK, and author of Grief Works and This Too Shall Pass.
Liz Gleeson – Creator of the Shapes of Grief podcast and internationally recognised grief educator and therapist.

This episode is essential listening for anyone working in pre-hospital, emergency, critical care, or healthcare environments where grief and loss are encountered as part of everyday practice.

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’s guest is Kodey Bogart, a pilot whose career bridges frontline combat aviation and the demanding, safety-critical environment of civilian helicopter operations. Dr. Kodey Bogart, AvD., is a former United States Army Warrant Officer and aviator who flew the Black Hawk on medical evacuation missions. A decorated combat veteran, she has been awarded two Air Medals and the prestigious Sikorsky Rescue Award. She also made history as the first female Pilot in Command in the Florida Army National Guard, qualified for day, night, and night vision goggle (NVG) combat operations.
Kodey’s experience spans aviation safety, flight instruction, maintenance, test flying, Helicopter Emergency Medical Services (HEMS), and aviation law enforcement. She brings both technical depth and operational insight to every mission she undertakes.
In this episode, we explore the realities behind high-stakes decision-making in HEMS, how crews manage risk under pressure, where safety systems hold up or fall short, and what pilots and clinicians can learn from each other in critical moments.
Beyond aviation, Kodey contributes to public service through Operation Helo, a charity addressing gaps in disaster response, and is the author of a children's book series introducing young readers to various aviation missions, including air ambulance. Both can be found here:
Kodey's children's book on Air Ambulance helicopter pilots can be found here: ⁠https://www.helogirls.com/⁠
Operation Helo: https://www.operationhelo.org/⁠

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/⁠