Culture Under Pressure: Frontline Voices on Ambulance Service Reform with Lee McLaren

In February 2023, the National Guardian’s Office dropped a stark warning: the culture in ambulance trusts across England was putting both staff wellbeing and patient safety at risk. Fast forward to this year’s Culture Review of Ambulance Trusts, and the findings are just as sobering.According to the 2022 NHS Staff Survey, ambulance services scored below the national average across all seven People Promise areas, including inclusion, wellbeing, morale, and leadership. Over 14% of paramedics reported that their workload was directly damaging their emotional wellbeing. And in terms of speaking up? Many staff who raised concerns said they faced intimidation, ostracism, or silence. The review also highlights ongoing issues with bullying, sexual harassment, poor line management, and a leadership style that too often leans on ‘command and control’ rather than compassion. But alongside these findings are six bold recommendations, from fixing the speak-up culture to creating leadership pathways that actually reflect what frontline staff need.So, in today’s episode, we’re asking, does this report reflect experience working on the frontline? What’s missing? And what does genuine culture change look like when you’re the one out there answering the calls? I’m joined in this interview by Lee McLaren. Lee is a Paramedic and Practice Educator with the Ambulance Service. With a focus on human-centric leadership, Lee champions compassionate, effective learning environments. His work bridges clinical excellence with the development of future healthcare professionals.You can read the report for the basis of the interview here: https://www.england.nhs.uk/long-read/culture-review-of-ambulance-trusts/

In this episode of the Pre-Hospital Care Podcast, we explore what effective paramedic mentorship should look like, drawing on Radu Venter’s article, “What Should Paramedic Mentorship Look Like?” The discussion examines the shortcomings of current orientation practices, highlighting how short and inconsistent programmes frequently leave newly qualified paramedics underprepared and lacking confidence.Many begin their careers paired with partners who have only slightly more experience, creating an environment that can contribute to early-career stress, limited support, and increased vulnerability to error.We introduce Radu's proposal for a more structured approach modelled on medical internships. Under this system, new paramedics would initially work as part of a full, experienced crew, gradually taking on greater responsibility while remaining under the supervision of a seasoned practitioner with at least two years of experience. This tiered framework would allow skills to develop progressively, building confidence and competence before transitioning to independent practice.We also explore evidence from existing models, including a one-year fellowship structure in British Columbia that has reportedly strengthened clinical decision-making, enhanced patient care, and improved practitioner wellbeing. The episode considers what EMS organisations would need to implement such a system, including cultural alignment, investment in senior clinicians, and a commitment to prioritising early-career development.Ultimately, the conversation underscores that structured mentorship is not simply an educational enhancement; it is a patient safety measure and a workforce sustainability strategy. The full article is available at: ⁠https://theparamedicphilosopher.substack.com/p/what-should-paramedic-mentorship⁠This 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/⁠⁠

On January 13th, 1982, Washington, DC, was paralyzed by a historic snowstorm when catastrophe struck, not once, but twice. Air Florida Flight 90 crashed into the 14th Street Bridge, sending wreckage and passengers plunging into the frozen Potomac River, while across the city, the Metro system suffered its first deadly derailment. Amid chaos and freezing temperatures, first responders, bystanders, and civilians came together in acts of extraordinary courage that defined one of the most harrowing days in the capital’s history. In this episode of the Pre-Hospital Care Podcast, we speak with journalist, author, and former EMT Bruce Goldfarb, whose new book 'The Worst Day: A Plane Crash, A Train Wreck, and Remarkable Acts of Heroism in Washington DC ' reconstructs that day minute by minute through the eyes of survivors, rescuers, and witnesses. Drawing from years of interviews and his own frontline experience, Bruce explores not only the operational challenges of that day but also the humanity, the improvisation, compassion, and resilience that emerged from disaster. You can find Bruce's book here: https://www.amazon.com/Worst-Day-Remarkable-Heroism-Washington/dp/1586424165This 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/⁠

We're joined again today by Radu Venter, Flight Paramedic and Substack blogger. Radu discusses the common sentiment that formal paramedic education is insufficient and that crucial learning happens only during on-the-job practice. Radu also acknowledges that this perspective holds some truth because schooling often overemphasises skills and background knowledge, and can sometimes fail to adequately prepare students for the unpredictability of real patient interactions and essential non-clinical skills like communication and delivering bad news. However, Radu argues that relying solely on on-the-job learning is flawed as practitioners may lack awareness, resources, or opportunities to develop certain competencies, often falling into the existing workplace culture. Therefore, the author suggests that educational institutions should incorporate subjects such as leadership, conflict resolution, humility, and inclusivity into the curriculum to provide a safer environment for developing these critical interpersonal skills before starting practice. You can read the blog here: https://theparamedicphilosopher.substack.com/p/the-real-learning-begins-on-the-jobThis 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 today's episode of the Prehospital Care Podcast, we explore the complex intersection of adolescent male violence, social media's influence, and its profound impact on the medical professionals responding to these incidents. We're honoured to welcome Dr Naomi Murphy, one of the UK's most respected forensic clinical psychologists and recently appointed Honorary Professor of Psychology at Nottingham Trent University. Naomi brings over 25 years of clinical experience working with complex trauma, particularly among young men who have experienced childhood adversity and gone on to display violent behaviour.The rising tide of youth violence presents unique challenges for prehospital care providers who witness its devastating consequences firsthand. As medical professionals, we often focus on treating physical trauma without fully addressing the psychological dimensions, both for our patients and ourselves. Throughout our conversation, we'll examine the psychological foundations of youth violence, explore how digital platforms have altered its expression, and discuss evidence-based approaches for supporting both victims and the medical professionals who care for them. Dr Murphy's groundbreaking trauma-focused therapy work within high-security settings offers valuable insights for emergency responders experiencing vicarious trauma. You can find Naomi's work here: https://www.centrefortherapy.com/therapists/naomi-murphy/This episode is brought to you by IndieBase.IndieBase is the smart, simple, and budget-friendly Electronic Patient Record (EPR) system designed specifically for the demands of HEMS and pre-hospital care. Whether you're responding solo, working within a flexible team, or managing care across a larger organisation, IndieBase is built to support you. It runs seamlessly on laptops, tablets, or smartphones, and crucially, it operates offline, ensuring you can document care wherever you are, even in the most remote environments. Developed from the proven platform of HEMSbase by Medic One Systems, IndieBase offers a familiar, intuitive interface with the rock-solid reliability clinicians need. It's ready for everything from festival medical cover to high-acuity critical care transfers.Key features include full integration with all major pre-hospital monitors, case review, and clinical governance modules, making it an ideal solution for teams preparing for CQC registration. A patient feedback module also helps drive service improvement and meaningful engagement. For clinicians working across multiple organisations, IndieBase provides a personal logbook that combines your data and links directly with your existing HEMSbase logbook.IndieBase EPR made simple, wherever you are.Find out more at https://indiebase.net/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 explore Radu Venter’s insightful article “EMS Decision-Making”, which challenges the deeply held belief that faster is always better in emergency medicine. Venter questions the culture of constant urgency in EMS, the idea that every decision must be made in seconds, and argues that this mindset can sometimes compromise patient care, particularly in complex or ambiguous clinical scenarios that exist outside the realm of immediate cardiac arrest.Drawing on the concept of the OODA Loop (Observe, Orient, Decide, Act), Venter highlights its limitations when rigidly applied to paramedic practice. While timely action remains vital, he suggests that taking a moment to pause, observe, and plan can often lead to more accurate decisions and improved outcomes.We discuss how typical EMS training environments, often built around high-speed, high-stress simulations, may inadvertently reinforce reaction over reflection. The conversation explores how a culture of mindful, measured decision-making can empower clinicians to better manage uncertainty, allocate resources effectively, and ultimately provide safer, higher-quality care. Join us as we reframe what “fast” really means in pre-hospital medicine.Read the full article here: https://substack.com/home/post/p-101941847

In this episode, we take a deeper look at the many faces of grief that pre-hospital professionals may encounter in the field, often in subtle, complex, and deeply human ways. While grief is commonly associated with death, it extends far beyond, touching every kind of loss: from separation and divorce to anticipatory grief, perinatal loss, and the unique pain of suicide bereavement.We’re joined once again by Liz Gleeson, psychotherapist, educator, and grief specialist, to explore these lesser discussed but critical aspects of grief. Together, we’ll examine disenfranchised grief, where people mourn losses that aren’t openly acknowledged or socially supported; anticipatory grief, where loved ones begin grieving before a death occurs; and specific experiences such as parental bereavement, sibling loss, grief in older adults, and grief following perinatal loss.We’ll also explore how non-death losses like divorce or family estrangement can trigger profound grief responses that may go unrecognised during emergency care. This conversation will help you better understand the many forms grief can take and offer insights into how you, as a pre-hospital professional, can provide more compassionate, informed, and sensitive care during some of life’s most difficult moments.You can find Liz's podcast "Shapes of Grief' podcast here: https://podcasts.apple.com/gb/podcast/shapes-of-grief/id1450116449This is Liz's website, where further training on grief can be found: https://shapesofgrief.com/

In this episode of the Pre-Hospital Care Podcast, we explore Radu Venter’s powerful piece “No One Dies From Pain”, written under his pseudonym The Paramedic Philosopher. The article challenges one of the most common sayings in Emergency Medical Services (EMS), the idea that “no one dies from pain.” While the phrase may have originated from a focus on rapid transport and prioritising life-saving interventions, Venter argues that this mindset risks neglecting an essential part of paramedic practice: the management of human suffering.Pain is not just a symptom; it’s a physiological stressor that can worsen shock, elevate heart rate, and impede recovery. By dismissing it, we not only overlook patient comfort but also potentially compromise outcomes. Venter calls for a more compassionate, patient-centred approach that recognises pain management as integral to modern paramedicine.In this discussion, we unpack how our attitudes toward pain reflect broader cultural values within EMS and consider how clinicians can balance speed with empathy. Join us as we challenge traditional thinking, explore evidence behind pain’s physiological impact, and discuss practical ways to ensure comfort and care coexist in the pre-hospital environment.Read the full article here: https://substack.com/home/post/p-103748534

In this episode, we bring together a remarkable group of guests to discuss an often overlooked but incredibly important condition, Spontaneous Coronary Artery Dissection (SCAD). Joining us today are a SCAD survivor, the clinician who treated her, and an advocate working to raise awareness and improve patient outcomes.Together, they share their powerful and unique perspectives on what SCAD is, how it presents, and the challenges faced in recognising it, particularly in the pre-hospital environment, where diagnostic overshadowing can easily occur. We explore why SCAD is sometimes missed, how it differs from other cardiac events, and what clinicians can do to better support patients who may be experiencing it.Most importantly, we hear the real lived experience of surviving SCAD, the uncertainty, recovery, and the crucial role of awareness and advocacy in improving care pathways.This conversation is both educational and deeply human, offering vital insights for pre-hospital professionals, clinicians, and anyone interested in improving outcomes for patients with this rare and often misunderstood condition. Tune in to hear their stories, their expertise, and how we can all play a part in recognising and responding to SCAD more effectively. You can find more on SCAD here: https://beatscad.org.uk/SCAD-for-Patients/What-is-SCAD

In this episode, we explore “Leaving Room for Rougher Edges in EMS” by Radu Venter, a powerful reflection on perfectionism in paramedicine. Radu is a Flight Paramedic based in Canada. He challenges the unrealistic pursuit of flawless performance in an unpredictable, high-pressure environment and asks when “good enough” should truly be enough. We discuss how flexibility, honesty, and self-compassion can replace self-criticism, and how embracing imperfection can actually strengthen team culture and patient care. Join us as we explore the realities of being human in emergency medicine.Read the full article here: https://substack.com/home/post/p-116881333This 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/